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BRIEF COMMUNICATION

Three Methods of Opioid Detoxification in a Primary Care Setting

A Randomized Trial

Patrick G. O'Connor, MD, MPH; Kathleen M. Carroll, PhD; Julia M. Shi, MD; Richard S. Schottenfeld, MD; Thomas R. Kosten, MD; and Bruce J. Rounsaville, MD

1 October 1997 | Volume 127 Issue 7 | Pages 526-530

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: clonidine, combined clonidine 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.

Author and Article Information

From the Yale University School of Medicine, New Haven, Connecticut.
Acknowledgments: The authors thank Stacey Bernasconi, Rosann Bisighini, Sister Janet Constantino, Lisa Newell, and Charla Nich for their assistance in the conduct and analysis of this study.
Grant Support: By grant R18DAO6963 from the National Institute on Drug Abuse.
Requests for Reprints: Patrick G. O'Connor, MD, MPH, Yale New Haven Hospital Primary Care Center, Yale University School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT 06520-8025.
Current Author Addresses: Dr. O'Connor: Yale New Haven Hospital Primary Care Center, Yale University School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT 06520.

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