title: Tincture of opium for treating opioid dependence: a systematic review of safety and efficacy.
abstract: Recently, there has been a growing interest in using opium tincture (OT) for treating opioid dependence in certain regions. We aimed to assess the evidence on its safety and efficacy for this indication.
  
  
  
  We searched several databases (CENTRAL, Medline, EMBASE, Web of Science, PsychINFO, ProQuest Dissertation and Theses Database, Iran Medex, clinicaltrials.gov and who.int/trialsearch) with no language or publication date limitations. Two reviewers selected randomized controlled trials (RCT), cohort/case-control/cross-sectional studies and case-series on safety or efficacy of OT for treating opioid dependence and then extracted reported measures of mentioned outcomes from selected studies. We used the Effective Public Health Practice Project (EPHPP) Quality Assessment tool for appraisal.
  
  
  
  From nine selected studies; in three RCTs and one cohort analytical analysis on detoxification, 110 patients were treated with 15-140 morphine equivalents/day (mEq/d) of OT; in four prospective and one retrospective uncontrolled case-series on long-term/maintenance treatment, 570 patients were treated with 100-400 mEq/d of OT. Only two studies on detoxification included a comparison: one concluded equal efficacy of OT and methadone in suppressing withdrawal symptoms (P = 0.32) and the other concluded OT to be less efficacious than buprenorphine/naloxone in suppressing withdrawal [OT = 12.20, 95% confidence interval (CI) = 11.00, 13.40]; control: 5.20 (95% CI = 4.69, 5.71) and craving (OT = 303.0, 95% CI = -144.664, 750.664; control: 0.0) but not significantly different (P = 0.26) in retaining participants in treatment. No major adverse events were reported.
  
  
  
  Conclusive recommendations about the safety and efficacy of opium tincture for treating opioid dependence are not possible at this time.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.|Institute of Mental Health, Centre of Health Evaluation and Outcome Sciences (CHEOS), University of British Columbia, Vancouver, BC, Canada.
authors.forename: Mohammadali
authors.initials: M
authors.lastname: Nikoo
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Nooshin
authors.initials: N
authors.lastname: Nikoo
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.|Department of Psychiatry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Sanam Javid
authors.initials: SJ
authors.lastname: Anbardan
authors.affiliation: Roozbeh substance use treatment clinic, Tehran, Iran.
authors.forename: Afshar
authors.initials: A
authors.lastname: Amiri
authors.affiliation: Psychiatric University Hospital, Basel, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Vogel
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.|Institute of Mental Health, Centre of Health Evaluation and Outcome Sciences (CHEOS), University of British Columbia, Vancouver, BC, Canada.
authors.forename: Fiona
authors.initials: F
authors.lastname: Choi
authors.affiliation: Department of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Amir Ali
authors.identifier: 0000-0002-6055-4457
authors.initials: AA
authors.lastname: Sepehry
authors.affiliation: Psychiatric University Hospital, Basel, Switzerland.
authors.forename: Amir Hooshang
authors.initials: AH
authors.lastname: Bagheri Valoojerdi
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.|Institute of Mental Health, Centre of Health Evaluation and Outcome Sciences (CHEOS), University of British Columbia, Vancouver, BC, Canada.
authors.forename: Kerry
authors.initials: K
authors.lastname: Jang
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.|Institute of Mental Health, Centre of Health Evaluation and Outcome Sciences (CHEOS), University of British Columbia, Vancouver, BC, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Schütz
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shahin
authors.initials: S
authors.lastname: Akhondzadeh
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.|Institute of Mental Health, Centre of Health Evaluation and Outcome Sciences (CHEOS), University of British Columbia, Vancouver, BC, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Krausz
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D006801:Humans; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D009892:Opium / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009892:Opium
keywords: Medication-assisted treatment; opiate dependence; opioid dependence; opium; review; substance use; tincture of opium; treatment