In-patient detoxification procedures, treatment retention, and post-treatment opiate use: comparison of lofexidine + naloxone, lofexidine + placebo, and methadone.
OBJECTIVE
In-treatment and post-treatment outcomes were compared for three detoxification procedures (lofexidine+naloxone, lofexidine+placebo naloxone, and methadone). SAMPLE AND DESIGN: The sample was 137 opiate dependent in-patients. Detoxification treatments were 6-day lofexidine+naloxone (n=45), lofexidine+placebo naloxone (n=46), or 10-day methadone reduction (n=46). A cohort study design was used with double-blind random allocation to lofexidine+naloxone versus lofexidine+placebo. Patients who did not consent to, or who were excluded from randomisation received methadone.


RESULTS
Outcome differences between treatment groups at follow-up were generally associated with length of stay post-detoxification rather than detoxification procedure. Among patients who were not opiate abstinent throughout follow-up (n=85), those who received lofexidine+naloxone detoxification reported a longer interval to first heroin use, with an interaction between detoxification medication and subsequent retention in treatment also identified.


CONCLUSIONS
Detoxification medication may influence medium-term opiate use outcomes via its effect upon retention in treatment.
McCambridge
J
J
National Addiction Centre, Institute of Psychiatry, King's College London, 4 Windsor Walk, Camberwell, London SE5 8AF, United Kingdom. jim.mccambridge@lshtm.ac.uk
Gossop
M
M
Beswick
T
T
Best
D
D
Bearn
J
J
Rees
S
S
Strang
J
J
D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003000:Clonidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015331:Cohort Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D012008:Recurrence; D016320:Substance Abuse Treatment Centers; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D003000:Clonidine; D008691:Methadone; C025655:lofexidine