A multi-center randomized trial of buprenorphine-naloxone versus clonidine for opioid detoxification: findings from the National Institute on Drug Abuse Clinical Trials Network.
OBJECTIVE
The clinical effectiveness of buprenorphine-naloxone (bup-nx) and clonidine for opioid detoxification in in-patient and out-patient community treatment programs was investigated in the first studies of the National Institute of Drug Abuse Clinical Trials Network.


METHODS
Diagnostic and Statistical Manual version IV (DSM IV)-diagnosed opioid-dependent individuals seeking short-term treatment were randomly assigned, in a 2 : 1 ratio favoring bup-nx, to a 13-day detoxification using bup-nx or clonidine.


METHODS
A total of 113 in-patients (77 bup-nx, 36 clonidine) and 231 out-patients (157 bup-nx, 74 clonidine) participated. Supportive interventions included appropriate ancillary medications and standard counseling procedures guided by a self-help handbook. The criterion for treatment success was defined as the proportion of participants in each condition who were both retained in the study for the entire duration and provided an opioid-free urine sample on the last day of clinic attendance. Secondary outcome measures included use of ancillary medications, number of side effects reported and withdrawal and craving ratings.


RESULTS
A total of 59 of the 77 (77%) in-patients assigned to the bup-nx condition achieved the treatment success criterion compared to eight of the 36 (22%) assigned to clonidine, whereas 46 of the 157 (29%) out-patients assigned to the bup-nx condition achieved the treatment success criterion, compared to four of the 74 (5%) assigned to clonidine.


CONCLUSIONS
The benefits of bup-nx for opioid detoxification are supported and illustrate important ways in which clinical research can be conducted in community treatment programs.
Ling
Walter
W
David Geffen School of Medicine, NPI/Integrated Substance Abuse Programs, University of California, Los Angeles, CA 90025, USA. lwalter@ix.netcom.com
Amass
Leslie
L
Shoptaw
Steve
S
Annon
Jeffrey J
JJ
Hillhouse
Maureen
M
Babcock
Dean
D
Brigham
Greg
G
Harrer
Judy
J
Reid
Malcolm
M
Muir
Joan
J
Buchan
Betty
B
Orr
Debbie
D
Woody
George
G
Krejci
Jonathan
J
Ziedonis
Douglas
D
D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D003000:Clonidine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008658:Inactivation, Metabolic; D008297:Male; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*
D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine; D003000:Clonidine