Three Methods of Opioid Detoxification in a Primary Care Setting

Three Methods of Opioid Detoxification in a Primary Care Setting

A Randomized Trial

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.

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: 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.