Buprenorphine for the Management of Opioid Withdrawal

University of Adelaide, Department of Clinical and Experimental Pharmacology, DASC Evidence-Bsed Practice Unit, Adelaide, AUSTRALIA, 5005.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2006; 2(2):CD002025. DOI: 10.1002/14651858.CD002025.pub3
Source: PubMed


Buprenorphine has potential as a medication to manage withdrawal from heroin, and possibly methadone. Dependence on opioid drugs (heroin, methadone) is a major health and social issue in many societies. Managed withdrawal from opioid dependence is an essential first step for drug-free treatment. The review of trials found that the drug buprenorphine has potential as a medication to reduce the signs and symptoms of withdrawal from heroin, and possibly methadone. These include irritability, anxiety, muscle and stomach pain, chills and nausea. The evidence is limited, but suggests that buprenorphine may be more effective than clonidine in reducing these signs and symptoms, and be associated with fewer adverse effects.

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    • "In the Cochrane review by Gowing et al. (2009a) (Ia), buprenorphine appeared equivalent to methadone at tapered doses in reducing the severity of withdrawal symptoms. The withdrawal symptoms may resolve more quickly with buprenorphine. "
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    ABSTRACT: The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.
    Journal of Psychopharmacology 05/2012; 26(7):899-952. DOI:10.1177/0269881112444324 · 3.59 Impact Factor
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    • "Naltrexone, an antagonist of the mu receptor, has been approved by the US FDA for treatment of alcohol dependence and blockade of the effects of opioids.5,27 Studies have reported the combination of buprenorphine and naltrexone to be associated with lower recurrence rate, lower tendency to use drugs, and higher percentage of negative urine samples.4 "
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    ABSTRACT: Since the number of drug users is increasing, applying a method of detoxification with fewer side effects during withdrawal from opioids and greater reliability seems to be necessary. In addition, without maintenance treatment, there will be limited success of treatment. This study aimed to compare success rates of detoxification with sublingual buprenorphine and clonidine and to evaluate addiction relapse in patients using naltrexone in a six-month follow-up. This double-blind trial was carried out on opioid dependent patients in a psychiatric hospital in Kerman (Iran) during 2007-09. The subjects were randomly selected from individuals who had referred for detoxification. They were allocated to two groups to receive either clonidine (n = 21) or buprenorphine (n = 14). The success rates of the two methods were assessed at the end of the course and patients were discharged while prescribed with 25 mg daily use of naltrexone. They were followed up for six months and the continuous use of naltrexone and relapse of substance abuse were evaluated. A total number of 35 patients entered the study. Success of detoxification with naltrexone was confirmed in all cases. One person (8.4%) in the clonidine group and no patient in the buprenorphine group had a clinical opiate withdrawal scale (COWS) score of more than 12 (P > 0.05). The mean levels of objective signs and subjective symptoms of withdrawal and the desire for drug abuse had significant reductions during detoxification period in both groups (P < 0.001). However, the difference in these variables between the two groups was not statistically significant (P > 0.05). Naltrexone was used for an average of one month in 43% and 64% of subjects in the clonidine and buprenorphine groups, respectively. In addition, 62% of patients in the clonidine group and 92.8% of subjects in the buprenorphine group received maintenance treatment. Nevertheless, the mean number of days staying in treatment was not significantly difference between the two groups (P > 0.05). Buprenorphine is as effective as clonidine in controlling withdrawal symptoms. A greater percentage of patients detoxified by buprenorphine received maintenance treatment, but there was not a significant difference in relapse rates between the two methods.
    03/2012; 4(3-4):79-86.
    • "Fewer data exist for direct comparisons of buprenorphine vs methadone for detoxification from heroin dependence. Gowing and colleagues conducted a Cochrane systematic review 18 studies involving 1356 participants of buprenorphine for management of opioid withdrawal.[14] However, only 14 studies were RCTs and just 4 compared buprenorphine with methadone. "
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    ABSTRACT: Heroin dependence is a major health and social problem associated with increased morbidity and mortality that adversely affects social circumstances, productivity, and healthcare and law enforcement costs. In the UK and many other Western countries, both methadone and buprenorphine are recommended by the relevant agencies for detoxification from heroin and for opioid maintenance therapy. However, despite obvious benefits due to its unique pharmacotherapy (eg, greatly reduced risk of overdose), buprenorphine has largely failed to overtake methadone in managing opioid addiction. The experience from the developing world (based on data from India) is similar. In this article we compare the advantages and disadvantages of the use methadone and buprenorphine for the treatment of opioid addiction from both a developed and developing world perspective; and explore some of the reasons why buprenorphine has not fulfilled the expectations predicted by many in the addictions field.
    Journal of Neurosciences in Rural Practice 03/2012; 3(1):45-50. DOI:10.4103/0976-3147.91934
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