Buprenorphine for the Management of Opioid Withdrawal

ArticleinCochrane database of systematic reviews (Online) 2(2):CD002025 · February 2006with7 Reads
DOI: 10.1002/14651858.CD002025.pub3 · Source: PubMed
Abstract
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.
    • "An increasing range of evidence-based treatment modalities have been found to be effective in improving outcomes from substance use disorder and attendant harms. For example, among individuals addicted to opioids, opioid substitution therapies (OST) including methadone and buprenorphine maintenance have been shown to reduce negative drug-related outcomes and to stabilize individuals suffering from opioid dependence (Amato, Davoli, Ferri, & Ali, 2002; Gowing, Ali, & White, 2004; Mattick, Breen, Kimber, & Davoli, 2009). In a recent review, use of Suboxone (a combination of buprenorphine and naloxone) was demonstrated to be effective for opioid withdrawal (As, Young, & Vieira, 2014; Ferri, Davoli, & Perucci, 2011; Krupitsky et al., 2011; Wolfe et al., 2011). "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Despite widespread implementation of compulsory treatment modalities for drug dependence, there has been no systematic evaluation of the scientific evidence on the effectiveness of compulsory drug treatment. Methods: We conducted a systematic review of studies assessing the outcomes of compulsory treatment. We conducted a search in duplicate of all relevant peer-reviewed scientific literature evaluating compulsory treatment modalities. The following academic databases were searched: PubMed, PAIS International, Proquest, PsycINFO, Web of Science, Soc Abstracts, JSTOR, EBSCO/Academic Search Complete, REDALYC, SciELO Brazil. We also searched the Internet, and article reference lists, from database inception to July 15th, 2015. Eligibility criteria are as follows: peer-reviewed scientific studies presenting original data. Primary outcome of interest was post-treatment drug use. Secondary outcome of interest was post-treatment criminal recidivism. Results: Of an initial 430 potential studies identified, nine quantitative studies met the inclusion criteria. Studies evaluated compulsory treatment options including drug detention facilities, short (i.e., 21-day) and long-term (i.e., 6 months) inpatient treatment, community-based treatment, group-based outpatient treatment, and prison-based treatment. Three studies (33%) reported no significant impacts of compulsory treatment compared with control interventions. Two studies (22%) found equivocal results but did not compare against a control condition. Two studies (22%) observed negative impacts of compulsory treatment on criminal recidivism. Two studies (22%) observed positive impacts of compulsory inpatient treatment on criminal recidivism and drug use. Conclusion: There is limited scientific literature evaluating compulsory drug treatment. Evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms. Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms.
    Full-text · Article · Dec 2015
    • "However, any physician can prescribe buprenorphine in the acute care setting for withdrawal. A metaanalysis comparing detoxification with methadone, buprenorphine, or clonidine determined that methadone or buprenorphine were the most effective at managing withdrawal symptoms [28]. Noska A, Mohan A, Wakeman S, Rich J, Boutwell A (2015) Before proceeding with methadone initiation for post-hospital maintenance, providers must discuss the appropriateness of methadone maintenance therapy with the patient. "
    Article · Jan 2015 · The International journal on drug policy
    • "Also, apart from the role of withdrawal medication in the prediction of outcome, early data have suggested that completers of detoxification may have a more severe psychological profile, expressed as symptoms on the Symptom checklist 90 (SCL- 90) measure [2]. A majority of studies comparing different strategies for opioid detoxification have been pharmacological trials comparing different medications [7] , and there has been considerably less research assessing other potential predictors of outcome in this area. Previous data—yet unpublished—from our group indicate that the presence of a postdetoxification plan may increase completion of detoxification [8]. "
    [Show abstract] [Hide abstract] ABSTRACT: Inpatient withdrawal treatment (detoxification) is common in opioid dependence, although dropout against medical advice often limits its outcome. This study aimed to assess baseline predictors of dropout from inpatient opioid detoxification with buprenorphine, including age, gender, current substance use, and type of postdetoxification planning. A retrospective hospital chart review was carried out for inpatient standard opioid detoxifications using buprenorphine taper, in a detoxification ward in Malmö, Sweden (N = 122). Thirty-four percent of patients (n = 42) dropped out against medical advice. In multivariate logistic regression, dropout was significantly associated with younger age (OR 0.93 [0.89-0.97]) and negatively predicted by inpatient postdetoxification plan (OR 0.41 [0.18-0.94]), thus favouring an inpatient plan as opposed to outpatient treatment while residing at home. Dropout was unrelated to baseline urine toxicology. In opioid detoxification, patients may benefit from a higher degree of postdetoxification planning, including transition to residential treatment, in order to increase the likelihood of a successful detoxification and treatment entry. Young opioid-dependent patients may need particular attention in the planning of detoxification.
    Full-text · Article · Oct 2014
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