Three methods of opioid detoxification in a primary care setting : A randomized trial

• Published in: Annals of internal medicine Vol. 127; no. 7; pp. 526 - 530
• Main Authors: O'CONNOR, P. G, CARROLL, K. M, SHI, J. M, SCHOTTENFELD, R. S, KOSTEN, T. R, ROUNSAVILLE, B. J
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American College of Physicians 01-10-1997
• Subjects: Adolescent; Adrenergic alpha-Agonists - therapeutic use; Adult; Biological and medical sciences; Buprenorphine - therapeutic use; Clonidine - therapeutic use; Double-Blind Method; Drug addictions; Drug Therapy, Combination; Female; Heroin - pharmacokinetics; Heroin Dependence - drug therapy; Heroin Dependence - metabolism; Humans; Inactivation, Metabolic; Male; Medical sciences; Middle Aged; Naltrexone - therapeutic use; Narcotic Antagonists - therapeutic use; Primary Health Care; Substance Withdrawal Syndrome; Toxicology; Human; Evaluation; Drug addiction; Nervous system diseases; Detoxication; Opiates; Health education; Naltrexone; Toxicology; Randomization; Health center; Buprenorphine; Double blind study; Clonidine; Psychopathology; Pharmacokinetics; Therapeutic protocol; Public health; Comparative study
• ISSN: 0003-4819; 1539-3704
• DOI: 10.7326/0003-4819-127-7-199710010-00004

Opioid detoxification in a primary care setting followed by ongoing substance abuse treatment may be appropriate for selected opioid-dependent patients.
To compare three pharmacologic protocols for opioid detoxification in a primary care setting.
Randomized, double-blind clinical trial with random assignment to treatment protocols.
A free-standing primary care clinic affiliated with drug treatment programs.
162 heroin-dependent patients.
Three detoxification protocols: donidine, combined donidine and naltrexone, and buprenorphine.
Successful detoxification (that is, when study participants received a full opioid-blocking dose [50 mg] of naltrexone), treatment retention (8 days), and withdrawal symptoms.
Overall, 65% of participants (36 of 55) who received clonidine, 81% (44 of 54) who received combined clonidine and naltrexone, and 81% (43 of 53) who received buprenorphine were successfully detoxified. Retention did not differ significantly across the groups: 65% of participants (36 of 55) who received clonidine, 54% (29 of 54) who received combined clonidine and naltrexone, and 60% (32 of 53) who received buprenorphine. Participants who received buprenorphine had a significantly lower mean withdrawal symptom score than those who received clonidine or combined clonidine and naltrexone.
Participants in the combined clonidine and naltrexone group and those in the buprenorphine group were more likely to complete detoxification, although retention at 8 days did not differ among the groups. Participants who were assigned to the buprenorphine group experienced less severe withdrawal symptoms than those assigned to the other two groups.