Preliminary assessment of a 10-day rapid detoxification programme using high dosage buprenorphine

The original French therapeutic strategy for the treatment of opioid addiction was a rapid detoxification occasionally accompanied by treatment for withdrawal symptoms. In 1995, substitution therapy using opioids was introduced with the aim of maintenance, utilising methadone and the partial agonist buprenorphine, introduced in 1996. As well as being a maintenance agent, buprenorphine has been prescribed for rapid detoxification due to its reduced tendency to cause any withdrawal effects and its ability to block the effects of other opioids. This trial was initiated to measure the efficacy of buprenorphine in rapid detoxification and to assess whether additional medication would be required. Participants in this open study had requested rapid detoxification and were referred to the addiction clinic as inpatients. Patients were assessed by the clinician and during counselling sessions, and an initial dose was agreed upon. This dose was then gradually decreased over ten days in a flexible dosing schedule, with concurrent toxicological urinalysis to ensure no illicit drug use. During the trial, 25% of patients transferred to a maintenance programme and 58% remained in the study. The large transfer of patients to maintenance programmes may indicate that many people requesting rapid detoxification are actually asking for a more generalised form of assistance. No opioid-positive urines were noted after the fourth day in any patients, and the study indicates that buprenorphine should prove to be a useful detoxification agent, particularly in less hardened addicts. Step-down buprenorphine detoxification minimises withdrawal symptoms and, therefore, reduces the need for concurrent medication.