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Buprenorphine for managing opioid withdrawal
Linda Gowing1, Robert Ali1, Jason M White2
1Discipline of Pharmacology, University of Adelaide, Frome Road, Adelaide, South Australia, Australia, 5005.
The Cochrane Database of Systematic Reviews
|February 22, 2017
Summary
Buprenorphine is more effective than clonidine or lofexidine for managing opioid withdrawal, improving treatment completion rates. Buprenorphine and methadone appear equally effective, though more research is needed on buprenorphine tapering.
Area of Science:
- Pharmacology and Addiction Medicine
- Evidence-Based Medicine
- Clinical Trial Analysis
Background:
- Managed withdrawal is crucial for initiating drug-free treatment or concluding substitution therapy.
- Opioid dependence management requires effective strategies for withdrawal symptom control.
Purpose of the Study:
- To compare the efficacy of buprenorphine against other interventions for opioid withdrawal.
- To assess buprenorphine's impact on withdrawal intensity, treatment duration, completion, and adverse effects.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials.
- Included studies compared buprenorphine with methadone, alpha2-adrenergic agonists, symptomatic treatments, or placebo.
- Searched multiple databases including CENTRAL, MEDLINE, Embase, PsycINFO, and Web of Science.
Main Results:
- Buprenorphine demonstrated superior outcomes compared to clonidine/lofexidine, reducing withdrawal severity and increasing treatment completion.
- Buprenorphine and methadone showed similar efficacy in ameliorating opioid withdrawal and in treatment duration/completion.
- Evidence regarding different buprenorphine tapering regimens was inconclusive due to study heterogeneity and low quality.
Conclusions:
- Buprenorphine is a more effective treatment for opioid withdrawal than clonidine or lofexidine.
- Buprenorphine and methadone appear comparable, but further research is needed.
- Optimal buprenorphine tapering strategies require further investigation, potentially considering transition to naltrexone.
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