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
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.
Available from: Anders Hakansson
- "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 . A majority of studies comparing different strategies for opioid detoxification have been pharmacological trials comparing different medications , 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 Previous data—yet unpublished—from our group indicate that the presence of a postdetoxification plan may increase completion of detoxification . "
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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.
Available from: David J Nutt
- "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.
Available from: PubMed Central
- "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.
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