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Three methods of opioid detoxification in a primary care setting. A randomized trial
P G O'Connor1, K M Carroll, J M Shi
1Yale New Haven Hospital Primary Care Center, Yale University School of Medicine, CT 06520-8025, USA.
Background:
Opioid detoxification in a primary care setting followed by ongoing substance abuse treatment may be appropriate for selected opioid-dependent patients.
Objective:
To compare three pharmacologic protocols for opioid detoxification in a primary care setting.
Design:
Randomized, double-blind clinical trial with random assignment to treatment protocols.
Setting:
A free-standing primary care clinic affiliated with drug treatment programs.
Patients:
162 heroin-dependent patients.
Interventions:
Three detoxification protocols: donidine, combined donidine and naltrexone, and buprenorphine.
Measurements:
Successful detoxification (that is, when study participants received a full opioid-blocking dose [50 mg] of naltrexone), treatment retention (8 days), and withdrawal symptoms.
Results:
Overall, 65% of participants (36 of 55) who received clonidine, 81% (44 of 54) who received combined clonidine and naltrexone, and 81% (43 of 53) who received buprenorphine were successfully detoxified. Retention did not differ significantly across the groups: 65% of participants (36 of 55) who received clonidine, 54% (29 of 54) who received combined clonidine and naltrexone, and 60% (32 of 53) who received buprenorphine. Participants who received buprenorphine had a significantly lower mean withdrawal symptom score than those who received clonidine or combined clonidine and naltrexone.
Conclusions:
Participants in the combined clonidine and naltrexone group and those in the buprenorphine group were more likely to complete detoxification, although retention at 8 days did not differ among the groups. Participants who were assigned to the buprenorphine group experienced less severe withdrawal symptoms than those assigned to the other two groups.
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