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Ann Intern Med. 1997 Oct 1;127(7):526-30.

Three methods of opioid detoxification in a primary care setting. A randomized trial.

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  • 1Yale New Haven Hospital Primary Care Center, Yale University School of Medicine, CT 06520-8025, USA.

Abstract

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.

PMID:
9313020
[PubMed - indexed for MEDLINE]
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