title: The association between outpatient buprenorphine detoxification duration and clinical treatment outcomes: a review.
abstract: BACKGROUND
  The association between buprenorphine taper duration and treatment outcomes is not well understood. This review evaluated whether duration of outpatient buprenorphine taper is significantly associated with treatment outcomes.
  
  
  METHODS
  Studies that were published in peer-reviewed journals, administered buprenorphine as an outpatient taper to opioid-dependent participants, and provided data on at least one of three primary treatment outcome measures (opioid abstinence, retention, peak withdrawal severity) were reviewed. Primary treatment outcomes were evaluated as a function of taper duration using hierarchical linear regressions with pre-taper maintenance duration as a cofactor.
  
  
  RESULTS
  Twenty-eight studies were reviewed. Taper duration significantly predicted percent of opioid-negative samples provided during treatment, however pre-taper maintenance period predicted percent participants abstinent on the final day of treatment. High rates of relapse were reported. No significant association between taper duration and retention in treatment or peak withdrawal severity was observed.
  
  
  CONCLUSIONS
  The data reviewed here suggest taper duration is associated with opioid abstinence achieved during detoxification but not with other markers of treatment outcome. The reviewed studies varied widely on several parameters (e.g., frequency of urinalysis testing, provision of ancillary medications) that may influence treatment outcome and thus could have interfered with the ability to identify relationships between taper duration and outcomes. Future studies evaluating opioid detoxification should utilize rigorous experimental methods and report a wider range of outcome measures in order to help advance our understanding of the association between taper duration and treatment outcomes.
authors: Johns Hopkins University, Baltimore, MD 21224, USA. kdunn9@jhmi.edu
authors: Kelly E
authors: KE
authors: Dunn
authors: Stacey C
authors: SC
authors: Sigmon
authors: Eric C
authors: EC
authors: Strain
authors: Sarah H
authors: SH
authors: Heil
authors: Stephen T
authors: ST
authors: Higgins
mesh_terms: D002047:Buprenorphine / Q000378:metabolism / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006801:Humans; D009292:Narcotic Antagonists / Q000378:metabolism / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000150:complications / Q000188:drug therapy*; D010045:Outpatients; D013375:Substance Withdrawal Syndrome / Q000150:complications / Q000188:drug therapy*; D019966:Substance-Related Disorders / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine