The association between outpatient buprenorphine detoxification duration and clinical treatment outcomes: A review

Abstract

Background The association between buprenorphine taper duration and treatment outcomes is not well understood. This review evaluated whether duration of outpatient buprenorphine taper is significantly associated with treatment outcomes. Methods Studies that were published in peer-reviewed journals, administered buprenorphine as an outpatient taper to opioid-dependent participants, and provided data on at least one of three primary treatment outcome measures (opioid abstinence, retention, peak withdrawal severity) were reviewed. Primary treatment outcomes were evaluated as a function of taper duration using hierarchical linear regressions using pre-taper maintenance as a cofactor. Results Twenty-eight studies were reviewed. Taper duration significantly predicted percent of opioid-negative samples provided during treatment, however pre-taper maintenance period predicted percent participants abstinent on the final day of treatment. High rates of relapse were reported. No significant association between taper duration and retention in treatment or peak withdrawal severity was observed. Conclusion The data reviewed here suggest taper duration is associated with opioid abstinence achieved during detoxification but not with other markers of treatment outcome. The reviewed studies varied widely on several parameters (e.g., frequency of urinalysis testing, provision of ancillary medications) that may influence treatment outcome and thus could have interfered with the ability to identify relationships between taper duration and outcomes. Future studies evaluating opioid detoxification should utilize rigorous experimental methods and report a wider range of outcome measures in order to help advance our understanding of the association between taper duration and treatment outcomes.

Individualizing Opioid Use Disorder (OUD) Treatment: Time to Fully Embrace a Chronic Disease Model

“…The common social sentiment, "Why don't these people stop doing drugs," is not just sewn into the fabric of our society, but has also permeated our healthcare system, treatment models, and our definitions of 'successful' treatment [12]. These beliefs are centered on a misguided understanding, which assumes that if a patient stops taking the opioid, then they are cured; however, this is not supported by the available evidence concerning detoxification and abstinence based treatment [13][14][15][16]. Additionally, buprenorphine/naloxone maintenance therapy has been shown to reduce rates of relapse, increase retention in treatment [17], and engage patients in psychosocial recovery models [18].…”

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

“…Although many patients will opt for agonist treatment,77 some do not want it, will only seek treatment in settings where it is unavailable, agree only to short‐term agonist treatment, or will want to try something else 78. For these patients, evidence largely suggests that a slow agonist taper provides superior outcomes to a rapid taper, although conflicting results have been reported 39, 79. Some patients, however, despite having been successfully treated with agonists long‐term, may be unable to complete the taper and may have to resume agonist maintenance.…”

“…Up to one third of patients who receive XR‐NTX use illicit opioids at some point during treatment, commonly as single episodes to “test” the blocking effect of the medication 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 62. A recent study of patients using opioids during XR‐NTX blockade found that most did not feel euphoria and used lower doses than before receiving XR‐NTX.…”

Opioid Detoxification and Naltrexone Induction Strategies: Recommendations for Clinical Practice

“…A number of studies have examined varying durations of opioid taper, particularly with buprenorphine (see (53) for review). More gradual tapers were generally associated with greater opioid abstinence during the taper than rapid tapers, though there was no significant association between taper duration and severity of withdrawal or retention at the end of detoxification.…”