Buprenorphine versus dihydrocodeine for opiate detoxification in primary care: a randomised controlled trial.
BACKGROUND
Many drug users present to primary care requesting detoxification from illicit opiates. There are a number of detoxification agents but no recommended drug of choice. The purpose of this study is to compare buprenorphine with dihydrocodeine for detoxification from illicit opiates in primary care.


METHODS
Open label randomised controlled trial in NHS Primary Care (General Practices), Leeds, UK. Sixty consenting adults using illicit opiates received either daily sublingual buprenorphine or daily oral dihydrocodeine. Reducing regimens for both interventions were at the discretion of prescribing doctor within a standard regimen of not more than 15 days. Primary outcome was abstinence from illicit opiates at final prescription as indicated by a urine sample. Secondary outcomes during detoxification period and at three and six months post detoxification were recorded.


RESULTS
Only 23% completed the prescribed course of detoxification medication and gave a urine sample on collection of their final prescription. Risk of non-completion of detoxification was reduced if allocated buprenorphine (68% vs 88%, RR 0.58 CI 0.35-0.96, p = 0.065). A higher proportion of people allocated to buprenorphine provided a clean urine sample compared with those who received dihydrocodeine (21% vs 3%, RR 2.06 CI 1.33-3.21, p = 0.028). People allocated to buprenorphine had fewer visits to professional carers during detoxification and more were abstinent at three months (10 vs 4, RR 1.55 CI 0.96-2.52) and six months post detoxification (7 vs 3, RR 1.45 CI 0.84-2.49).


CONCLUSIONS
Informative randomised trials evaluating routine care within the primary care setting are possible amongst drug using populations. This small study generates unique data on commonly used treatment regimens.
Wright
Nat M J
NM
Centre for Research in Primary Care, 71-75 Clarendon Road, Leeds, LS2 9PL, UK. n.wright@leeds.ac.uk
Sheard
Laura
L
Tompkins
Charlotte N E
CN
Adams
Clive E
CE
Allgar
Victoria L
VL
Oldham
Nicola S
NS
D000328:Adult; D000701:Analgesics, Opioid / Q000493:pharmacokinetics / Q000627:therapeutic use* / Q000652:urine; D002047:Buprenorphine / Q000493:pharmacokinetics / Q000627:therapeutic use* / Q000652:urine; D003061:Codeine / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008658:Inactivation, Metabolic; D008297:Male; D009293:Opioid-Related Disorders / Q000378:metabolism / Q000534:rehabilitation*; D017410:Practice Guidelines as Topic / Q000592:standards; D011320:Primary Health Care; D006113:United Kingdom
D000701:Analgesics, Opioid; D002047:Buprenorphine; C014481:dihydrocodeine; D003061:Codeine