Clonidine Increases the Likelihood That Abstinence Can Withstand Unstructured Time in Buprenorphine-maintained Outpatients

Abstract

Objective In a clinical trial examining daily clonidine as an adjunct to buprenorphine treatment for opioid dependence, we found that clonidine increased opioid abstinence and decoupled stress from craving. From a personalized-medicine perspective, the next step is to identify people for whom clonidine would be beneficial. To that end, using data from the same clinical trial, we examined the associations of daily-life activities with treatment success. Methods Outpatients (N=118) received clonidine (0.3 mg/day) or placebo during 18 weeks of buprenorphine treatment. Participants carried a smartphone that randomly prompted them 4 times per day to report their moods and activities. Using generalized linear mixed models, we assessed the likelihoods of different types of daily activity as a function of clonidine vs. placebo, days of longest continuous opioid abstinence, and their interaction. Results Participants in the buprenorphine-only (placebo plus clonidine) control group who engaged in more responsibilities (work and child/elder care) had longer streaks of abstinence, while those who engaged in more unstructured-time activities had shorter streaks of abstinence. Conversely, for participants in the buprenorphine-plus-clonidine group, longer streaks of abstinence were associated with higher frequencies of activities associated with unstructured time. Conclusions The study replicates findings that engaging in responsibilities is related to positive treatment outcomes in standard opioid agonist therapy. The pattern of results also suggests that clonidine helped participants engage in unstructured-time activities with less risk of craving or use than they might otherwise have had.

Conjugate vaccine produces long-lasting attenuation of fentanyl vs. food choice and blocks expression of opioid withdrawal-induced increases in fentanyl choice in rats

“…Continuous 7-day treatment with the α 2 adrenergic agonist clonidine was selected as an active negative control. Clonidine will relieve some somatic opioid withdrawal signs in opioid-dependent OUD patients and has been shown to decrease stress-induced reinstatement in rats as well as reduce the risk of relapse when used as an adjunct to buprenorphine in humans [23][24][25]. However, clonidine does not prevent relapse when used as a monotherapy [26].…”

Learnings from a prison‐based drug treatment program on planning for release: A qualitative study

“…This controlled trial concerning the use of clonidine as an adjunct to buprenorphine, provided participants with a portable device that would prompt them at four random intervals a day to record their current level of craving and any activities they were engaging in presently. The authors found that engaging in responsibilities is related to positive treatment outcomes in individuals receiving standard opioid agonist therapy [ 32 ]. Although our study was qualitative, it complements the literature suggesting that good treatment outcomes arise from commitments and responsibilities [ 33 , 34 , 35 ].…”

“…The D&A program appeared to provide a novel forum where men were able to discuss their internal emotional state. The prison population has a high prevalence of emotional burden [ 32 ]. This is contributed to by the situation inmates are in and the difficult life circumstances leading to incarceration.…”