TY - JOUR
KW - Analgesics, Opioid/therapeutic use
KW - Buprenorphine, Naloxone Drug Combination/therapeutic use
KW - Clonidine/analogs & derivatives/therapeutic use
KW - Craving/drug effects
KW - Double-Blind Method
KW - Drug Therapy, Combination
KW - Female
KW - Humans
KW - Male
KW - Methadone/therapeutic use
KW - Narcotic Antagonists/therapeutic use
KW - Opioid-Related Disorders/drug therapy
KW - Substance Withdrawal Syndrome/drug therapy
KW - Treatment Outcome
KW - Young Adult
KW - buprenorphine
KW - Detoxification
KW - lofexidine
KW - Methadone
KW - opiate withdrawal
AU - F. D. Law
AU - A. M. Diaper
AU - J. K. Melichar
AU - S. Coulton
AU - D. J. Nutt
AU - J. S. Myles
A1 - 
AB - Buprenorphine/naloxone, methadone and lofexidine are medications with utility in the treatment of opiate withdrawal. We report the first randomised controlled trial to compare the effects of these two medications on withdrawal symptoms and outcome during opiate induction/stabilisation and detoxification. A double-blind randomised controlled trial was conducted in an outpatient satellite clinic of a specialist drug service. Eighty opiate dependent individuals meeting DSM-IV criteria for opiate dependence, using (1/2) g heroin smoked/chased or (1/4) g heroin injected or 30mg methadone, with 3 years of opioid dependency, underwent a short-term opiate treatment programme involving induction/stabilisation on methadone 30mg or buprenorphine/naloxone 4mg/1mg, followed by detoxification (where the methadone group was assisted by lofexidine). The main outcome measures were urine drug screens for opiates and withdrawal and craving questionnaires. There were no overall differences in positive urine drug screens and drop-outs during any phase of the study. During induction/stabilisation, withdrawal symptoms subsided more slowly for buprenorphine/naloxone than for methadone, and craving was significantly higher in the buprenorphine/naloxone group ( p<0.05, 95% confidence interval -3.5, -0.38). During detoxification, withdrawal symptoms were significantly greater and the peak of withdrawal was earlier for the methadone/lofexidine group than the buprenorphine/naloxone group ( p<0.01, 95% confidence interval 3.0, 8.3). Methadone/lofexidine and buprenorphine/naloxone had comparable outcomes during rapid outpatient stabilisation and detoxification in low dose opiate users.
AD - 1 Avon & Wiltshire Specialist Drug & Alcohol Services, Chippenham, UK.; 2 Psychopharmacology Unit, Social and Community Medicine, University of Bristol, Bristol, UK.; 2 Psychopharmacology Unit, Social and Community Medicine, University of Bristol, Bristol, UK.; 3 Centre for Health Services Studies, Faculty of Social Sciences, Cornwallis North East, University of Kent, Canterbury, UK.; 4 Neuropsychopharmacology Unit, Imperial College London, London, UK.; 5 St George's Hospital Medical School, London, UK.
BT - Journal of psychopharmacology (Oxford, England)
C5 - Opioids & Substance Use
CP - 8
CY - United States
DO - 10.1177/0269881117711710
IS - 8
JF - Journal of psychopharmacology (Oxford, England)
M1 - Journal Article
N2 - Buprenorphine/naloxone, methadone and lofexidine are medications with utility in the treatment of opiate withdrawal. We report the first randomised controlled trial to compare the effects of these two medications on withdrawal symptoms and outcome during opiate induction/stabilisation and detoxification. A double-blind randomised controlled trial was conducted in an outpatient satellite clinic of a specialist drug service. Eighty opiate dependent individuals meeting DSM-IV criteria for opiate dependence, using (1/2) g heroin smoked/chased or (1/4) g heroin injected or 30mg methadone, with 3 years of opioid dependency, underwent a short-term opiate treatment programme involving induction/stabilisation on methadone 30mg or buprenorphine/naloxone 4mg/1mg, followed by detoxification (where the methadone group was assisted by lofexidine). The main outcome measures were urine drug screens for opiates and withdrawal and craving questionnaires. There were no overall differences in positive urine drug screens and drop-outs during any phase of the study. During induction/stabilisation, withdrawal symptoms subsided more slowly for buprenorphine/naloxone than for methadone, and craving was significantly higher in the buprenorphine/naloxone group ( p<0.05, 95% confidence interval -3.5, -0.38). During detoxification, withdrawal symptoms were significantly greater and the peak of withdrawal was earlier for the methadone/lofexidine group than the buprenorphine/naloxone group ( p<0.01, 95% confidence interval 3.0, 8.3). Methadone/lofexidine and buprenorphine/naloxone had comparable outcomes during rapid outpatient stabilisation and detoxification in low dose opiate users.
PP - United States
PY - 2017
SN - 1461-7285; 0269-8811
SP - 1046
EP - 1055
EP - 
T1 - Buprenorphine/naloxone versus methadone and lofexidine in community stabilisation and detoxification: A randomised controlled trial of low dose short-term opiate-dependent individuals
T2 - Journal of psychopharmacology (Oxford, England)
TI - Buprenorphine/naloxone versus methadone and lofexidine in community stabilisation and detoxification: A randomised controlled trial of low dose short-term opiate-dependent individuals
U1 - Opioids & Substance Use
U2 - 28631527
U3 - 10.1177/0269881117711710
VL - 31
VO - 1461-7285; 0269-8811
Y1 - 2017
Y2 - Aug
ER -