Short-ten,n outcomes of five heroin detoxification methods in the Australian NEPOD Project

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
Addictive Behaviors (Impact Factor: 2.76). 04/2005; 30(3):443-56. DOI: 10.1016/j.addbeh.2004.06.002
Source: PubMed


This study included 380 participants in five heroin detoxification trials whose data were pooled to enable direct comparison of five detoxification methods in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD). Rapid detoxification achieved similar initial abstinence rates with either anaesthesia or sedation (average 59%), which were higher than was achieved by inpatient detoxification using clonidine plus other symptomatic medications (24%), which in turn was higher than outpatient detoxification using either buprenorphine (12%) or clonidine plus other symptomatic medications (4%). Older participants and those using more illicit drugs were more likely to achieve abstinence. Entry rates into ongoing postdetoxification treatment were as follows: buprenorphine outpatient (65%), sedation (63%), anaesthesia (42%), symptomatic outpatient (27%), and symptomatic inpatient (12%). Postdetoxification treatment with buprenorphine or methadone was preferred over naltrexone. Participants with more previous detoxification attempts were more likely to enter postdetoxification treatment. Given that outpatient detoxification was more effective with buprenorphine than with symptomatic medications and that rapid detoxification was more effective than the symptomatic inpatient method, the roles of the symptomatic methods should be reconsidered.

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Available from: Erol Digiusto, Oct 12, 2014
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    • "Drug dependence, a psychiatric disorder with biological, psychological and social dimensions, is considered as a major problem in Iran. The prevalence of drug dependence among human societies has increased clearly.1,2 Since medical issues, mental illness of companions, and other related factors such as family breakdown, unemployment, and legal issues are all of high prevalence among drug addicts, these individuals are a serious problem for the Iranian Department of Health and other social services in the country.2 "
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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.
    Full-text · Article · Mar 2012
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    • "A Kruskal–Wallis was used for overall comparison and multiple comparisons with Mann–Whitney tests were done where indicated. In Digiusto et al. (2005), outcomes were analysed using logistic regression, with a set of baseline participant characteristic variables used as covariates to address the possibility of baseline differences between the sub-groups of participants who entered the various detoxification methods. However, as full data on covariates were not available for all participants, it was decided to use the raw outcome data in the estimation of the ICERs in the present study. "
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    ABSTRACT: This economic evaluation was part of the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD) project. Data from four trials of heroin detoxification methods, involving 365 participants, were pooled to enable a comprehensive comparison of the cost-effectiveness of five inpatient and outpatient detoxification methods. This study took the perspective of the treatment provider in assessing resource use and costs. Two short-term outcome measures were used-achievement of an initial 7-day period of abstinence, and entry into ongoing post-detoxification treatment. The mean costs of the various detoxification methods ranged widely, from AUD 491 dollars(buprenorphine-based outpatient); to AUD 605 dollars for conventional outpatient; AUD 1404 dollars for conventional inpatient; AUD 1990 dollars for rapid detoxification under sedation; and to AUD 2689 dollars for anaesthesia per episode. An incremental cost-effectiveness analysis was carried out using conventional outpatient detoxification as the base comparator. The buprenorphine-based outpatient detoxification method was found to be the most cost-effective method overall, and rapid opioid detoxification under sedation was the most cost-effective inpatient method.
    Full-text · Article · Apr 2006 · Addictive Behaviors
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    • " the nature of the interventions , blinding was not possible . A range of co - medication was allowed . The only SAEs recorded were in the anaesthesia group . One patient developed pulmonary oedema , one developed a mixed bipolar state , and one developed diabetic ketoacidosis . All three episodes were related to prior conditions and experiences . Digiusto et al . ( 2005 ) pooled the data from 5 detoxification trials . However , the two that involved buprenorphine were either included in the Cochrane Review or excluded from that analysis . Ling et al . ( 2005 ) assigned 113 in - patients and 231 out - patients to buprenorphine - naltrexone or clonidine - assisted detoxification in a 2 : 1 ratio . This w"

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