Detox With Buprenorphine More Lasting Than Clonidine

SCOTTSDALE, ARIZ. – Opiate addicts who go through withdrawal using buprenorphine are nine times more likely to complete their withdrawal regimen than are patients who use clonidine, a large National Institute on Drug Abuse-sponsored trial shows.

In addition, buprenorphine might be that much-sought-after key to getting more opiate abusers invested in their longer-term psychotherapy treatment, Leslie Amass, Ph.D., said at the annual meeting of the American Academy of Addiction Psychiatry.

The study involved 344 opiate-addicted subjects who were randomized to either a 13-day schedule of tapered withdrawal using buprenorphine-naloxone (Suboxone) or a tapered withdrawal using clonidine patches. The patients came from 12 centers; 113 patients were detoxified as inpatients and 231 as outpatients. Most were heroin abusers, and many had been in treatment before.

No problems were found with the early doses of buprenorphine. All of the patients took and tolerated their first day's dose of 8 mg, and 90% completed the induction phase of treatment. During that phase, the dose was increased to 16 mg before being cut back, said Dr. Amass, a principal investigator with the Friends Research Institute Inc., Los Angeles.

Overall, 68% of the buprenorphine-detoxified patients completed the full process, compared with only 30% of the clonidine patients.

Moreover, 77% of the inpatient, buprenorphine-detoxified patients completed and tested negative for illicit opiate use on day 14, compared with 22% of the inpatient, clonidine-detoxified patients. The same was true for 29% of the buprenorphine-treated outpatients and 5% of the clonidine-treated outpatients.

Fewer adverse events occurred in the buprenorphine-treated patients, and most were related to withdrawal. They included insomnia (62%), arthralgia (54%), and anxiety (52%). Only one of the serious adverse events was deemed potentially related to buprenorphine: a case of hematemesis that might have been a general opioid reaction.

“The big message here is that if you are going to pursue a short-term intervention focused on medical withdrawal for opiate addiction, buprenorphine is the way to go,” Dr. Amass said.

Longer follow-up of these patients has been difficult, as is typical with drug-treatment patients. But there is good reason to think that buprenorphine serves as a better bridge to long-term treatment for more patients, Dr. Amass said.

Several studies have tried to document this influence, including a recently reported investigation that followed adolescents. The study found that almost two-thirds of the adolescents treated with buprenorphine alone completed a 4-week course and transferred to naloxone maintenance. But only 5% of those treated with clonidine had done so (Arch. Gen. Psychiatry 2005;62:1157–64).

“That's unheard of in the treatment of adolescents,” Dr. Amass said.

The centers involved in the National Institute on Drug Abuse study had such a positive experience with buprenorphine and have become so convinced it leads to long-term treatment that almost all have continued their programs, she said.

The exceptions have been the study's methadone clinics, which are legally prohibited from changing drug treatments.

Two of the centers that have continued with buprenorphine are very prominent treatment centers that previously have eschewed pharmacologic detoxification of this kind: the Betty Ford Center in Rancho Mirage, Calif., and Phoenix House in New York.

Phoenix House notes that, of the first group of patients admitted to its buprenorphine withdrawal program, 90% completed detoxification and 76% continued into long-term treatment.

In a coordinated study at Phoenix House, almost 50% of 38 patients admitted to the program, completed a full 3-month treatment regimen. That compared with about 60% of 37 nonopiate drug abusers. Historically, the retention rate of opiate users is significantly lower than that of other drug or alcohol abusers.

The staff at Phoenix House attributes its better retention partly to the condition of its patients during the initial days of their stays. Phoenix House patients tend to be well enough during those early days to absorb the message delivered by counselors that recovery requires more than simply detoxification, Dr. Amass said.

The remaining contribution to retention probably has to do with the pharmacology of buprenorphine.

Buprenorphine “is the single best predictor of retention, regardless of setting,” Dr. Amass said.

SCOTTSDALE, ARIZ. – Opiate addicts who go through withdrawal using buprenorphine are nine times more likely to complete their withdrawal regimen than are patients who use clonidine, a large National Institute on Drug Abuse-sponsored trial shows.

In addition, buprenorphine might be that much-sought-after key to getting more opiate abusers invested in their longer-term psychotherapy treatment, Leslie Amass, Ph.D., said at the annual meeting of the American Academy of Addiction Psychiatry.

The study involved 344 opiate-addicted subjects who were randomized to either a 13-day schedule of tapered withdrawal using buprenorphine-naloxone (Suboxone) or a tapered withdrawal using clonidine patches. The patients came from 12 centers; 113 patients were detoxified as inpatients and 231 as outpatients. Most were heroin abusers, and many had been in treatment before.

No problems were found with the early doses of buprenorphine. All of the patients took and tolerated their first day's dose of 8 mg, and 90% completed the induction phase of treatment. During that phase, the dose was increased to 16 mg before being cut back, said Dr. Amass, a principal investigator with the Friends Research Institute Inc., Los Angeles.

Overall, 68% of the buprenorphine-detoxified patients completed the full process, compared with only 30% of the clonidine patients.

Moreover, 77% of the inpatient, buprenorphine-detoxified patients completed and tested negative for illicit opiate use on day 14, compared with 22% of the inpatient, clonidine-detoxified patients. The same was true for 29% of the buprenorphine-treated outpatients and 5% of the clonidine-treated outpatients.

Fewer adverse events occurred in the buprenorphine-treated patients, and most were related to withdrawal. They included insomnia (62%), arthralgia (54%), and anxiety (52%). Only one of the serious adverse events was deemed potentially related to buprenorphine: a case of hematemesis that might have been a general opioid reaction.

“The big message here is that if you are going to pursue a short-term intervention focused on medical withdrawal for opiate addiction, buprenorphine is the way to go,” Dr. Amass said.

Longer follow-up of these patients has been difficult, as is typical with drug-treatment patients. But there is good reason to think that buprenorphine serves as a better bridge to long-term treatment for more patients, Dr. Amass said.

Several studies have tried to document this influence, including a recently reported investigation that followed adolescents. The study found that almost two-thirds of the adolescents treated with buprenorphine alone completed a 4-week course and transferred to naloxone maintenance. But only 5% of those treated with clonidine had done so (Arch. Gen. Psychiatry 2005;62:1157–64).

“That's unheard of in the treatment of adolescents,” Dr. Amass said.

The centers involved in the National Institute on Drug Abuse study had such a positive experience with buprenorphine and have become so convinced it leads to long-term treatment that almost all have continued their programs, she said.

The exceptions have been the study's methadone clinics, which are legally prohibited from changing drug treatments.

Two of the centers that have continued with buprenorphine are very prominent treatment centers that previously have eschewed pharmacologic detoxification of this kind: the Betty Ford Center in Rancho Mirage, Calif., and Phoenix House in New York.

Phoenix House notes that, of the first group of patients admitted to its buprenorphine withdrawal program, 90% completed detoxification and 76% continued into long-term treatment.

In a coordinated study at Phoenix House, almost 50% of 38 patients admitted to the program, completed a full 3-month treatment regimen. That compared with about 60% of 37 nonopiate drug abusers. Historically, the retention rate of opiate users is significantly lower than that of other drug or alcohol abusers.

The staff at Phoenix House attributes its better retention partly to the condition of its patients during the initial days of their stays. Phoenix House patients tend to be well enough during those early days to absorb the message delivered by counselors that recovery requires more than simply detoxification, Dr. Amass said.

The remaining contribution to retention probably has to do with the pharmacology of buprenorphine.

Buprenorphine “is the single best predictor of retention, regardless of setting,” Dr. Amass said.

SCOTTSDALE, ARIZ. – Opiate addicts who go through withdrawal using buprenorphine are nine times more likely to complete their withdrawal regimen than are patients who use clonidine, a large National Institute on Drug Abuse-sponsored trial shows.

In addition, buprenorphine might be that much-sought-after key to getting more opiate abusers invested in their longer-term psychotherapy treatment, Leslie Amass, Ph.D., said at the annual meeting of the American Academy of Addiction Psychiatry.

The study involved 344 opiate-addicted subjects who were randomized to either a 13-day schedule of tapered withdrawal using buprenorphine-naloxone (Suboxone) or a tapered withdrawal using clonidine patches. The patients came from 12 centers; 113 patients were detoxified as inpatients and 231 as outpatients. Most were heroin abusers, and many had been in treatment before.

No problems were found with the early doses of buprenorphine. All of the patients took and tolerated their first day's dose of 8 mg, and 90% completed the induction phase of treatment. During that phase, the dose was increased to 16 mg before being cut back, said Dr. Amass, a principal investigator with the Friends Research Institute Inc., Los Angeles.

Overall, 68% of the buprenorphine-detoxified patients completed the full process, compared with only 30% of the clonidine patients.

Moreover, 77% of the inpatient, buprenorphine-detoxified patients completed and tested negative for illicit opiate use on day 14, compared with 22% of the inpatient, clonidine-detoxified patients. The same was true for 29% of the buprenorphine-treated outpatients and 5% of the clonidine-treated outpatients.

Fewer adverse events occurred in the buprenorphine-treated patients, and most were related to withdrawal. They included insomnia (62%), arthralgia (54%), and anxiety (52%). Only one of the serious adverse events was deemed potentially related to buprenorphine: a case of hematemesis that might have been a general opioid reaction.

“The big message here is that if you are going to pursue a short-term intervention focused on medical withdrawal for opiate addiction, buprenorphine is the way to go,” Dr. Amass said.

Longer follow-up of these patients has been difficult, as is typical with drug-treatment patients. But there is good reason to think that buprenorphine serves as a better bridge to long-term treatment for more patients, Dr. Amass said.

Several studies have tried to document this influence, including a recently reported investigation that followed adolescents. The study found that almost two-thirds of the adolescents treated with buprenorphine alone completed a 4-week course and transferred to naloxone maintenance. But only 5% of those treated with clonidine had done so (Arch. Gen. Psychiatry 2005;62:1157–64).

“That's unheard of in the treatment of adolescents,” Dr. Amass said.

The centers involved in the National Institute on Drug Abuse study had such a positive experience with buprenorphine and have become so convinced it leads to long-term treatment that almost all have continued their programs, she said.

The exceptions have been the study's methadone clinics, which are legally prohibited from changing drug treatments.

Two of the centers that have continued with buprenorphine are very prominent treatment centers that previously have eschewed pharmacologic detoxification of this kind: the Betty Ford Center in Rancho Mirage, Calif., and Phoenix House in New York.

Phoenix House notes that, of the first group of patients admitted to its buprenorphine withdrawal program, 90% completed detoxification and 76% continued into long-term treatment.

In a coordinated study at Phoenix House, almost 50% of 38 patients admitted to the program, completed a full 3-month treatment regimen. That compared with about 60% of 37 nonopiate drug abusers. Historically, the retention rate of opiate users is significantly lower than that of other drug or alcohol abusers.

The staff at Phoenix House attributes its better retention partly to the condition of its patients during the initial days of their stays. Phoenix House patients tend to be well enough during those early days to absorb the message delivered by counselors that recovery requires more than simply detoxification, Dr. Amass said.

The remaining contribution to retention probably has to do with the pharmacology of buprenorphine.

Buprenorphine “is the single best predictor of retention, regardless of setting,” Dr. Amass said.