Clinical Trial Evaluates Outpatient Detoxification in Prescription Opioid Abusers


 Patients addicted to prescription opioids (POs) who are taking buprenorphine (a medication used in opioid addiction treatment) may respond better to tapering of the drug over four weeks than over shorter periods when the taper is followed by naltrexone (a medication that blocks opioid strength), according to a clinical trial report by Stacey C. Sigmon, Ph.D., of the University of Vermont, Burlington, and colleagues.

 Abuse of prescription opioid drugs, such as oxycodone, hydrocodone and hydromorphone, are a public health problem, according to the study background.

 Researchers conducted a two-phase, 12-week clinical trial in an outpatient research clinic with 70 PO-dependent patients to evaluate outpatient detoxification treatment. After a two-week period of taking buprenorphine, patients were randomized to taper the buprenorphine (slowly reduce the dose) over one, two or four weeks followed by naltrexone therapy. Patients in all groups were given behavioral therapy.

 The study findings indicate that opioid abstinence was greater with the four-week compared with the two-week and one-week tapers.

 The results suggest that some PO abusers may respond favorably to outpatient treatment with buprenorphine detoxification followed by naltrexone against a backdrop of behavioral therapy, according to the authors.

“Additional controlled studies are needed to better understand the parameters of efficacious treatments for PO dependence, as well as to identify the individuals for whom brief vs. longer-term treatments are warranted,” the authors conclude.

JAMA Psychiatry. Published online October 23, 2013. doi:10.1001/jamapsychiatry.2013.2216.