title: Short-term outcomes of five heroin detoxification methods in the Australian NEPOD Project.
abstract: 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.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia. e.digiusto@unsw.edu.au
authors.forename: Erol
authors.initials: E
authors.lastname: Digiusto
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
authors.forename: Courtney
authors.initials: C
authors.lastname: Breen
authors.forename: Jo
authors.initials: J
authors.lastname: Kimber
authors.forename: Richard P
authors.initials: RP
authors.lastname: Mattick
authors.forename: James
authors.initials: J
authors.lastname: Bell
authors.forename: Robert
authors.initials: R
authors.lastname: Ali
authors.forename: John B
authors.initials: JB
authors.lastname: Saunders
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000379:methods; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000758:Anesthesia / Q000379:methods; D002047:Buprenorphine / Q000627:therapeutic use; D005260:Female; D006556:Heroin Dependence / Q000188:drug therapy* / Q000534:rehabilitation; D006760:Hospitalization; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008658:Inactivation, Metabolic; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009292:Narcotic Antagonists; D002047:Buprenorphine; D009271:Naltrexone; D008691:Methadone