title: Characterizing opioid withdrawal during double-blind buprenorphine detoxification.
abstract: BACKGROUND
  Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification.
  
  
  METHODS
  This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatient buprenorphine tapers among primary prescription opioid (PO) abusers. The aim is to characterize the time course and severity of buprenorphine withdrawal under rigorous, double-blind conditions, across multiple taper durations, and using multiple withdrawal-related measures (i.e., self-report and observer ratings, pupil diameter, ancillary medication utilization). Participants were PO-dependent adults undergoing buprenorphine detoxification and biochemically-verified to be continuously abstinent from opioids during their taper (N = 28).
  
  
  RESULTS
  Participants randomly assigned to the 4-week taper regimen experienced a relatively mild and stable course of withdrawal, with few peaks in severity. In contrast, the 1- and 2-week taper groups experienced stark increases in withdrawal severity during the week following the last buprenorphine dose, followed by declines in withdrawal severity thereafter. The 4-week taper group also reported significantly fewer disruptions in sleep compared to the other experimental groups. When predictors of withdrawal were examined, baseline ratings of "Expected Withdrawal Severity" was the most robust predictor of withdrawal experienced during the taper.
  
  
  CONCLUSIONS
  Data from this trial may inform clinicians about the expected time course, magnitude, and pattern of buprenorphine withdrawal and aid efforts to identify patients who may need additional clinical support during outpatient buprenorphine detoxification.
authors.affiliation: Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, United States. Electronic address: kdunn9@jhmi.edu.
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Dunn
authors.affiliation: University of Pennsylvania School of Medicine, Philadelphia, PA, United States.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Saulsgiver
authors.affiliation: Brown University Center for Alcohol and Addiction Studies, Providence, RI, United States.
authors.forename: Mollie E
authors.initials: ME
authors.lastname: Miller
authors.affiliation: Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nuzzo
authors.affiliation: University of Vermont Departments of Psychiatry, Burlington, VT, United States; University of Vermont Departments of Psychology, Burlington, VT, United States.
authors.forename: Stacey C
authors.initials: SC
authors.lastname: Sigmon
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D062072:Patient Acuity; D063487:Prescription Drug Misuse; D013375:Substance Withdrawal Syndrome; D016896:Treatment Outcome; D014481:United States
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine
keywords: Buprenorphine; Detoxification; Prescription opioid; Taper; Withdrawal
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