Detoxification of Opiate Addicts with Multiple Drug Abuse: a Comparison of Buprenorphine vs. Methadone

Seifert, J.; Metzner, C; Paetzold, W.; Borsutzky, Mathias; Passie, Torsten; Rollnik, Jens D.; Wiese, Beth M; Emrich, H. M.; Schneider, Udo

doi:10.1055/s-2002-34115

Cited by 43 publications

(29 citation statements)

References 33 publications

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“…The highest levels of opiate withdrawal found in the multiple substance disorder group (MSD) lead to hypothesize that the primary dependence in MSD subjects was more severe than the correspondent dependence on the single substance, so that subthreshold symptoms of protracted withdrawal could still be detected in them by rating. It is in fact known that the abuse of multiple substances is associated with a more complicated and sustained withdrawal syndrome [47] .…”

Section: Discussionmentioning

confidence: 99%

Anhedonia and Substance-Related Symptoms in Detoxified Substance-Dependent Subjects: A Correlation Study

Janiri¹,

Martinotti²,

Dario³

et al. 2005

Neuropsychobiology

132

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Anhedonia is a condition in which the capacity of experiencing pleasure is totally or partially lost, frequently occurring in mood disorders, as a negative symptom in schizophrenia, and in substance use disorders. In order to test a set of instruments for anhedonia in a population of detoxified opiate, alcohol and multiple substance-dependent subjects, 70 individuals were recruited from three different clinical settings. The following scales were applied: Snaith-Hamilton Pleasure Scale (SHAPS), Bech-Rafaelsen Melancholia Scale (BRMS), Scale for the Assessment of Negative Symptoms (SANS), specific withdrawal scales, and visual analogue scales (VAS) for hedonic capability and substance craving. The scales measuring anhedonia either directly (SHAPS, VAS for hedonic capability) or in some key items (SANS, BRMS) were significantly correlated with each other. The period of time since detoxification was inversely correlated with anhedonia and withdrawal symptomatology. Craving was positively correlated with anhedonia. Out of the total sample, only 18.5% could be defined as psychometrically anhedonic. The same correlations were found in this subsample. The composite instrument employed for assessing anhedonia and hedonic capability was found to be sensitive enough to detect such a dimension in the population considered, with the single scales significantly interrelated. In conclusion, we found interrelations between hedonic capability, craving and protracted withdrawal, particularly in opiate-dependent subjects. The strongest association occurred between hedonic capability and craving.

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Section: Discussionmentioning

confidence: 99%

Anhedonia and Substance-Related Symptoms in Detoxified Substance-Dependent Subjects: A Correlation Study

Janiri¹,

Martinotti²,

Dario³

et al. 2005

Neuropsychobiology

132

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“…The authors are aware of only six published studies. [20][21][22][23][24][25] A Cochrane Review of buprenorphine detoxification and maintenance studies concluded that completion of withdrawal treatment is possibly more likely when managed with buprenorphine compared to methadone. 26 However, the difference was not statistically significant and no data were reported on post-detoxification outcomes, leading the authors to conclude that more research was needed to evaluate possible differences in effectiveness between the two medications.…”

Section: Methodsmentioning

confidence: 99%

“…26 Only three studies had a primary outcome of abstinence from opiates evidenced by biochemical urine sample. 20,21,24 Only two studies used comparative statistics and one acknowledged small sample size as a limitation that affected significance. Both community-based studies demonstrated no significant difference between buprenorphine and methadone, for either abstinence 20 or retention in drug treatment.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Comparison of methadone and buprenorphine for opiate detoxification (LEEDS trial): a randomised controlled trial

Wright¹,

Sheard²,

Adams³

et al. 2011

Br J Gen Pract

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BackgroundMany opiate users require prescribed medication to help them achieve abstinence, commonly taking the form of a detoxification regime. In UK prisons, drug users are nearly universally treated for their opiate use by primary care clinicians, and once released access GP services where 40% of practices now treat drug users. There is a paucity of evidence evaluating methadone and buprenorphine (the two most commonly prescribed agents in the UK) for opiate detoxification. AimTo evaluate whether buprenorphine or methadone help to achieve drug abstinence at completion of a reducing regimen for heroin users presenting to UK prison health care for detoxification. DesignOpen-label, pragmatic, randomised controlled trial in three prison primary healthcare departments in the north of England. MethodPrisoners (n = 306) using illicit opiates were recruited and given daily sublingual buprenorphine or oral methadone, in the context of routine care, over a standard reduced regimen of not more than 20 days. The primary outcome measure was abstinence from illicit opiates at 8 days post detoxification, as indicated by urine test (self-report/clinical notes where urine sample was not feasible). Secondary outcomes were also recorded. ResultsAbstinence was ascertained for 73.7% at 8 days post detoxification (urine sample = 52.6%, self report = 15.2%, clinical notes = 5.9%). There was no statistically significant difference in the odds of achieving abstinence between methadone and buprenorphine (odds ratio [OR] = 1.69; 95% confidence interval [CI] = 0.81 to 3.51; P = 0.163). Abstinence was associated solely with whether or not the participant was still in prison at that time (15.22 times the odds; 95% CI = 4.19 to 55.28). The strongest association for lasting abstinence was abstinence at an earlier time point. ConclusionThere is equal clinical effectiveness between methadone and buprenorphine in achieving abstinence from opiates at 8 days post detoxification within prison.

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“…10 Dose reduction of buprenorphine appears to be associated with less severe withdrawal effects than withdrawal from methadone, whereas a switch to buprenorphine can be more problematic than initiation of treatment with methadone. 11,12 However, the effects of the 2 drugs on the circadian rhythm have still not been sufficiently investigated. Although there are some data on the effects of acute administration of opioids on sleep architecture in healthy adults, 13 little is known of the effects on sleep in chronic users during opioid detoxification.…”

mentioning

confidence: 99%

Actigraphic Measurements in Opioid Detoxification With Methadone or Buprenorphine

Pjrek

Frey²,

Naderi-Heiden³

et al. 2012

Journal of Clinical Psychopharmacology

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The objective of the present naturalistic study was to assess the differential effects of opioid detoxification with methadone or buprenorphine on activity, circadian rhythm, and sleep. Forty-two consecutive inpatients with opiate addiction were switched to either methadone or buprenorphine and gradually tapered down over the course of 2 to 3 weeks. There were no significant differences in comedication (lofexidine, quetiapine, and valproic acid) between the methadone and buprenorphine groups. Patients in the methadone group showed 11% lower activity and were 24 minutes phase delayed as compared with buprenorphine-treated patients, whereas the latter had 2.5% lower sleep efficiency and 9% shorter actual sleep time. These significant group differences were most pronounced for the lowest doses (≤20% of maximum individual daily dose, ie, at the end of withdrawal representing late withdrawal effects). Furthermore, for the total sample, we found a significant decrease in the relative amplitude of the sleep-wake cycle and worsening of all actigraphic sleep parameters from the higher (100% to 20%) to the lowest doses (20% to 0%). The acrophase of the circadian rhythm displayed a phase advance (-88 minutes) from the highest (100% to 80%) to the lower doses (80% to 0%) in methadone-treated patients. Opioid tapering with methadone or buprenorphine leads to characteristic changes of the rest-activity cycle, but further study is required to validate these results.

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Detoxification of Opiate Addicts with Multiple Drug Abuse: a Comparison of Buprenorphine vs. Methadone

Cited by 43 publications

References 33 publications

Anhedonia and Substance-Related Symptoms in Detoxified Substance-Dependent Subjects: A Correlation Study

Anhedonia and Substance-Related Symptoms in Detoxified Substance-Dependent Subjects: A Correlation Study

Comparison of methadone and buprenorphine for opiate detoxification (LEEDS trial): a randomised controlled trial

Actigraphic Measurements in Opioid Detoxification With Methadone or Buprenorphine

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