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Alpha2-adrenergic agonists in opioid withdrawal
Linda R Gowing1, Michael Farrell, Robert L Ali
1Evidence-Based Practice Unit, Drug and Alcohol Services Council, Parkside, SA, Australia. gowing.linda@saugov.sa.gov.au
Addiction (Abingdon, England)
|March 16, 2002
Summary
Alpha2-adrenergic agonists offer comparable opioid withdrawal symptom management to methadone, but patients may stay in treatment longer with methadone. Alpha2-adrenergic agonists may be preferred for earlier symptom resolution.
Area of Science:
- Pharmacology
- Addiction Medicine
- Clinical Trials
Background:
- Opioid withdrawal management is crucial for treatment retention.
- Alpha2-adrenergic agonists are explored as an alternative to traditional methods like methadone tapering.
- Systematic reviews are essential for synthesizing evidence on treatment efficacy.
Purpose of the Study:
- To systematically review the effectiveness of alpha2-adrenergic agonists in managing opioid withdrawal.
- To compare alpha2-adrenergic agonists with methadone reduction and placebo in controlled trials.
Main Methods:
- A Cochrane systematic review was conducted.
- Included are controlled trials comparing alpha2-adrenergic agonists to other treatments or placebo.
- Participants were primarily opioid-dependent.
Main Results:
- Withdrawal intensity was similar or slightly greater with alpha2-adrenergic agonists compared to methadone.
- Alpha2-adrenergic agonists led to earlier symptom resolution but potentially lower treatment completion rates.
- Clonidine showed more adverse effects than methadone; lofexidine had less impact on blood pressure than clonidine.
Conclusions:
- Methadone regimens may promote longer treatment engagement and psychosocial intervention, particularly in outpatient settings with high relapse risk.
- Alpha2-adrenergic agonists, like clonidine and lofexidine, can be effective for inpatient withdrawal, with lofexidine being more suitable for outpatient use due to fewer hypotensive effects.