The purpose of this study is to assess the adhesion of BTDS patch 40 µg/h.

The objective is to show non-inferiority in adhesion of BTDS patch 40 µg/h compared to BTDS patch 20 µg/h. Safety and tolerability of both patches will also be assessed.

1. Provide written informed consent.
2. Healthy male or female subjects aged 18 to 55 inclusive.
3. Female subjects of child bearing potential must be willing to use two highly effective methods of contraception throughout the study, one of which must include a barrier method.
4. Female subjects who are postmenopausal (defined as spontaneous amenorrhoea for at least 1 year) or permanently sterilised (e.g. tubal occlusion, hysterectomy, bilateral salpingectomy). These subjects are not required to use any contraception.
5. Male subjects who are willing to use contraception with their partners throughout the study and for 30 days after completion of the study and agree to inform the Investigator if their partner becomes pregnant during this time.
6. Body weight ranging from 55 to 100 kg and a BMI ≥ 18.5 and ≤ 30.0.
7. Healthy and free of significant abnormal findings as determined by medical history, physical examination, vital signs, laboratory tests and ECG.
8. The subject's primary care physician has confirmed within the last 12 months of first dosing that there is nothing in the subject's medical history that would preclude their enrolment into a clinical study.

Exclusion Criteria

Subjects to be excluded from the study are those who meet any of the following criteria:

1. Female subjects who are pregnant or lactating.

2. Any history of drug or alcohol abuse.

3. Any history of conditions that might interfere with drug absorption, distribution, metabolism or excretion.

4. Use of opioid or opioid antagonist-containing medication in the past 30 days.

5. Any history of frequent nausea or vomiting regardless of aetiology.

6. Any history of seizures or symptomatic head trauma.

7. Participation in a clinical drug study during the 90 days preceding the initial dose in this study, or participation in any other clinical drug study during this study.

8. Any significant illness during the 4 weeks preceding entry into this study.

9. A history of additional risk factors for Torsades de Pointes (e.g. heart failure, hypokalaemia, personal or family history of long QT syndrome, syncope, or family history of sudden death).

10. Abnormal cardiac conditions including any of the following:

    • QTcF interval greater than 450 msec at screening or at check-in before first dosing.
    • Increase in QTcF of more than 60 msec above pre-dose values of each study period or QTcF > 500 msec at any time during the study.

11. Use of medication within 5 times the half-life or minimum 14 days for prescription medication or 7 days for over-the-counter preparations (including vitamins, herbal and/or mineral supplements), whichever is longer, before the first dose of study treatment and during the study (with the exception of the continued use of Hormone Replacement Therapy (HRT) and contraceptives).

12. Refusal to abstain from caffeine or xanthine containing beverages and grapefruit juice within 48 hours before IMP administration until after the last study measure has been performed in each study period.

13. Weekly alcohol intake exceeding the equivalent of 14 units/week for females and 21 units/week for males.

14. Consumption of alcoholic beverages within 48 hours before IMP administration, and refusal to abstain from alcohol for the duration of the study confinement and for at least 48 hours after the last naltrexone dose in each study period.

15. History of smoking within 45 days of IMP administration and refusal to abstain from smoking during the study.

16. Positive results of urine drug screen, alcohol test and pregnancy test.

17. Known sensitivity to buprenorphine, naltrexone, related compounds or any of the excipients or any contraindications as detailed in the Butrans Summary of Product Characteristics or Nemexin Summary of Product Characteristics.

18. Clinically significant history of allergic reaction to wound dressings or elastoplast.

19. Subjects with any dermatological disorder or tattoos at the proposed sites of patch application, or with a history of eczema/cutaneous atrophy.

20. Subjects who will not allow hair to be removed at the proposed patch application sites which may prevent proper placement of the patch.

21. Refusal to allow their primary care physician to be informed of participation in the trial.