Effectiveness of interventions on opiate withdrawal treatment: an overview of systematic reviews.
OBJECTIVE
To provide an overview of 5 Cochrane reviews of different approaches for treating opioid withdrawal.


METHODS
Narrative and quantitative summary of review findings.


METHODS
There were 46 studies included in the original reviews with a total of 3350 participants (range 18-300).


METHODS
The 5 reviews considered 46 studies covering seven different comparisons, the major ones being methadone compared with alpha2-adrenergic agonists and other opioid agonists, different alpha2-adrenergic agonists compared with each other and to antagonist-induced withdrawal and buprenorphine.


METHODS
The outcomes considered were signs and symptoms of withdrawal, retention in treatment, completion rate, relapse rate and side effects.


RESULTS
Methadone detoxification results in higher retention in treatment, lower relapse rate and fewer side effects when compared with adrenergic agonists. No difference was observed when comparing different adrenergic agonists; buprenorphine appears to have an advantage over adrenergic agonists on withdrawal symptoms and side effects.


CONCLUSIONS
Despite the considerable number of trials that have been carried out on this topic, they are very heterogeneous as far as the comparisons and outcomes considered. This prevented many of them from being incorporated into a quantitative meta-analysis. Consensus in measurements and results should be reached among researchers involved in the evaluation of the effectiveness of treatments for opiate addiction in order to produce consistent outcomes in the measuring and reporting of results from clinical trials.
Amato
Laura
L
Department of Epidemiology, Via S Costanza, 53, 00198 Rome, Italy. tossidip1@asplazio.it
Davoli
Marina
M
Ferri
Marica
M
Gowing
Linda
L
Perucci
Carlo A
CA
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002047:Buprenorphine / Q000627:therapeutic use; D006801:Humans; D008691:Methadone / Q000008:administration & dosage / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009294:Narcotics / Q000009:adverse effects* / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control; D015203:Reproducibility of Results; D012196:Review Literature as Topic; D055502:Secondary Prevention; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D000929:Antidepressive Agents, Tricyclic; D009292:Narcotic Antagonists; D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone