title: Treatment of polydrug-using opiate dependents during withdrawal: towards a standardisation of treatment.
abstract: BACKGROUND
  The growing tendency among opioid addicts to misuse multiple other drugs should lead clinicians and researchers to search for new pharmacological strategies in order to prevent life-threatening complications and minimize withdrawal symptoms during polydrug detoxification.
  
  
  METHODS
  A non-randomised, open-label in-patient detoxification study was used to compare the short-time efficacy of a standardised regimen comprising 6 days Buprenorphine and 10 days Valproate (BPN/VPA) (n = 12) to a control group (n = 50) who took a 10-day traditional Clonidine/Carbamazepine (CLN/CBZ) regimen. Sixty-two dependent subjects admitted to a detoxification unit were included, all dependent on at least opioids and benzodiazepines. Other dependencies were not excluded.
  
  
  RESULTS
  In the BPN/VPA group, 8 out of 12 patients (67%) completed treatment compared with 25 of 50 patients (50%) in the CLN/CBZ group; this difference between the groups was non-significant (p = 0.15). Withdrawal symptoms were reduced in both groups, but only the BPN/VPA group achieved a reduction in withdrawal symptoms from day one. The difference between the two groups was significantly in favour of the BPN/VPA group for days 2 (p < 0.001), 3 (p < 0.05), 4 (p < 0.001), 5 (p < 0.01), 7 (p < 0.01) and 8 (p < 0.05). The BPN/VPA combination did not affect blood pressure, pulse or liver function, and the total burden of side-effects was experienced as modest. There appeared to be no pharmacological interactions of clinical concern, based on measurement of Buprenorphine and Valproate serum levels. Both the patients and the staff were satisfied with the standardised treatment combination.
  
  
  CONCLUSIONS
  Overall, the combination of Buprenorphine and Valproate seems to be a safe and promising method for treating multiple drug withdrawal symptoms. The results of this study suggest that the BPN/VPA combination is potentially a better detoxification treatment for polydrug withdrawal than the traditional treatment with Clonidine and Carbamazepine. However, a randomised, double-blind study with a larger sample size to confirm our results is recommended.
authors.affiliation: Addiction Unit, Sørlandet Hospital, Kristiansand, Norway. oistein.kristensen@sshf.no
authors.forename: Øistein
authors.initials: Ø
authors.lastname: Kristensen
authors.forename: Terje
authors.initials: T
authors.lastname: Lølandsmo
authors.forename: Ase
authors.initials: A
authors.lastname: Isaksen
authors.forename: John-Kåre
authors.initials: JK
authors.lastname: Vederhus
authors.forename: Thomas
authors.initials: T
authors.lastname: Clausen
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects*; D002047:Buprenorphine / Q000627:therapeutic use; D002220:Carbamazepine / Q000627:therapeutic use; D003000:Clonidine / Q000627:therapeutic use; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000534:rehabilitation*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy / Q000517:prevention & control*; D019966:Substance-Related Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000534:rehabilitation*; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D002220:Carbamazepine; D002047:Buprenorphine; D014635:Valproic Acid; D003000:Clonidine