Three methods of opioid detoxification in a primary care setting. A randomized trial.
BACKGROUND
Opioid detoxification in a primary care setting followed by ongoing substance abuse treatment may be appropriate for selected opioid-dependent patients.


OBJECTIVE
To compare three pharmacologic protocols for opioid detoxification in a primary care setting.


METHODS
Randomized, double-blind clinical trial with random assignment to treatment protocols.


METHODS
A free-standing primary care clinic affiliated with drug treatment programs.


METHODS
162 heroin-dependent patients.


METHODS
Three detoxification protocols: donidine, combined donidine and naltrexone, and buprenorphine.


METHODS
Successful detoxification (that is, when study participants received a full opioid-blocking dose [50 mg] of naltrexone), treatment retention (8 days), and withdrawal symptoms.


RESULTS
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.


CONCLUSIONS
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.
O'Connor
P G
PG
Yale New Haven Hospital Primary Care Center, Yale University School of Medicine, CT 06520-8025, USA.
Carroll
K M
KM
Shi
J M
JM
Schottenfeld
R S
RS
Kosten
T R
TR
Rounsaville
B J
BJ
D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D003000:Clonidine / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D003932:Heroin / Q000493:pharmacokinetics; D006556:Heroin Dependence / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D008658:Inactivation, Metabolic; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D011320:Primary Health Care; D013375:Substance Withdrawal Syndrome
D000316:Adrenergic alpha-Agonists; D009292:Narcotic Antagonists; D002047:Buprenorphine; D009271:Naltrexone; D003932:Heroin; D003000:Clonidine