Characterizing opioid withdrawal during double-blind buprenorphine detoxification

Kelly Dunn, Kathryn A. Saulsgiver, Mollie E. Miller, Paul A. Nuzzo, Stacey C. Sigmon

Research output: Contribution to journalArticle

Abstract

Background: Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification. Methods: This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatient buprenorphine tapers among primary prescription opioid (PO) abusers. The aim is to characterize the time course and severity of buprenorphine withdrawal under rigorous, double-blind conditions, across multiple taper durations, and using multiple withdrawal-related measures (i.e., self-report and observer ratings, pupil diameter, ancillary medication utilization). Participants were PO-dependent adults undergoing buprenorphine detoxification and biochemically-verified to be continuously abstinent from opioids during their taper (N= 28). Results: Participants randomly assigned to the 4-week taper regimen experienced a relatively mild and stable course of withdrawal, with few peaks in severity. In contrast, the 1- and 2-week taper groups experienced stark increases in withdrawal severity during the week following the last buprenorphine dose, followed by declines in withdrawal severity thereafter. The 4-week taper group also reported significantly fewer disruptions in sleep compared to the other experimental groups. When predictors of withdrawal were examined, baseline ratings of "Expected Withdrawal Severity" was the most robust predictor of withdrawal experienced during the taper. Conclusion: Data from this trial may inform clinicians about the expected time course, magnitude, and pattern of buprenorphine withdrawal and aid efforts to identify patients who may need additional clinical support during outpatient buprenorphine detoxification.

Original languageEnglish (US)
Pages (from-to)47-55
Number of pages9
JournalDrug and Alcohol Dependence
Volume151
DOIs
StatePublished - Jun 1 2015

Fingerprint

Buprenorphine
Detoxification
Opioid Analgesics
Prescriptions
Outpatients
Public health
Pupil
Self Report
Sleep
Public Health
Placebos

Keywords

  • Buprenorphine
  • Detoxification
  • Prescription opioid
  • Taper
  • Withdrawal

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Toxicology
  • Pharmacology
  • Pharmacology (medical)

Cite this

Characterizing opioid withdrawal during double-blind buprenorphine detoxification. / Dunn, Kelly; Saulsgiver, Kathryn A.; Miller, Mollie E.; Nuzzo, Paul A.; Sigmon, Stacey C.

In: Drug and Alcohol Dependence, Vol. 151, 01.06.2015, p. 47-55.

Research output: Contribution to journalArticle

Dunn, Kelly ; Saulsgiver, Kathryn A. ; Miller, Mollie E. ; Nuzzo, Paul A. ; Sigmon, Stacey C. / Characterizing opioid withdrawal during double-blind buprenorphine detoxification. In: Drug and Alcohol Dependence. 2015 ; Vol. 151. pp. 47-55.
@article{8aaddb5368c04c48a87dd35f525d9694,
title = "Characterizing opioid withdrawal during double-blind buprenorphine detoxification",
abstract = "Background: Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification. Methods: This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatient buprenorphine tapers among primary prescription opioid (PO) abusers. The aim is to characterize the time course and severity of buprenorphine withdrawal under rigorous, double-blind conditions, across multiple taper durations, and using multiple withdrawal-related measures (i.e., self-report and observer ratings, pupil diameter, ancillary medication utilization). Participants were PO-dependent adults undergoing buprenorphine detoxification and biochemically-verified to be continuously abstinent from opioids during their taper (N= 28). Results: Participants randomly assigned to the 4-week taper regimen experienced a relatively mild and stable course of withdrawal, with few peaks in severity. In contrast, the 1- and 2-week taper groups experienced stark increases in withdrawal severity during the week following the last buprenorphine dose, followed by declines in withdrawal severity thereafter. The 4-week taper group also reported significantly fewer disruptions in sleep compared to the other experimental groups. When predictors of withdrawal were examined, baseline ratings of {"}Expected Withdrawal Severity{"} was the most robust predictor of withdrawal experienced during the taper. Conclusion: Data from this trial may inform clinicians about the expected time course, magnitude, and pattern of buprenorphine withdrawal and aid efforts to identify patients who may need additional clinical support during outpatient buprenorphine detoxification.",
keywords = "Buprenorphine, Detoxification, Prescription opioid, Taper, Withdrawal",
author = "Kelly Dunn and Saulsgiver, {Kathryn A.} and Miller, {Mollie E.} and Nuzzo, {Paul A.} and Sigmon, {Stacey C.}",
year = "2015",
month = "6",
day = "1",
doi = "10.1016/j.drugalcdep.2015.02.033",
language = "English (US)",
volume = "151",
pages = "47--55",
journal = "Drug and Alcohol Dependence",
issn = "0376-8716",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Characterizing opioid withdrawal during double-blind buprenorphine detoxification

AU - Dunn, Kelly

AU - Saulsgiver, Kathryn A.

AU - Miller, Mollie E.

AU - Nuzzo, Paul A.

AU - Sigmon, Stacey C.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Background: Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification. Methods: This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatient buprenorphine tapers among primary prescription opioid (PO) abusers. The aim is to characterize the time course and severity of buprenorphine withdrawal under rigorous, double-blind conditions, across multiple taper durations, and using multiple withdrawal-related measures (i.e., self-report and observer ratings, pupil diameter, ancillary medication utilization). Participants were PO-dependent adults undergoing buprenorphine detoxification and biochemically-verified to be continuously abstinent from opioids during their taper (N= 28). Results: Participants randomly assigned to the 4-week taper regimen experienced a relatively mild and stable course of withdrawal, with few peaks in severity. In contrast, the 1- and 2-week taper groups experienced stark increases in withdrawal severity during the week following the last buprenorphine dose, followed by declines in withdrawal severity thereafter. The 4-week taper group also reported significantly fewer disruptions in sleep compared to the other experimental groups. When predictors of withdrawal were examined, baseline ratings of "Expected Withdrawal Severity" was the most robust predictor of withdrawal experienced during the taper. Conclusion: Data from this trial may inform clinicians about the expected time course, magnitude, and pattern of buprenorphine withdrawal and aid efforts to identify patients who may need additional clinical support during outpatient buprenorphine detoxification.

AB - Background: Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification. Methods: This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatient buprenorphine tapers among primary prescription opioid (PO) abusers. The aim is to characterize the time course and severity of buprenorphine withdrawal under rigorous, double-blind conditions, across multiple taper durations, and using multiple withdrawal-related measures (i.e., self-report and observer ratings, pupil diameter, ancillary medication utilization). Participants were PO-dependent adults undergoing buprenorphine detoxification and biochemically-verified to be continuously abstinent from opioids during their taper (N= 28). Results: Participants randomly assigned to the 4-week taper regimen experienced a relatively mild and stable course of withdrawal, with few peaks in severity. In contrast, the 1- and 2-week taper groups experienced stark increases in withdrawal severity during the week following the last buprenorphine dose, followed by declines in withdrawal severity thereafter. The 4-week taper group also reported significantly fewer disruptions in sleep compared to the other experimental groups. When predictors of withdrawal were examined, baseline ratings of "Expected Withdrawal Severity" was the most robust predictor of withdrawal experienced during the taper. Conclusion: Data from this trial may inform clinicians about the expected time course, magnitude, and pattern of buprenorphine withdrawal and aid efforts to identify patients who may need additional clinical support during outpatient buprenorphine detoxification.

KW - Buprenorphine

KW - Detoxification

KW - Prescription opioid

KW - Taper

KW - Withdrawal

UR - http://www.scopus.com/inward/record.url?scp=84929958667&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929958667&partnerID=8YFLogxK

U2 - 10.1016/j.drugalcdep.2015.02.033

DO - 10.1016/j.drugalcdep.2015.02.033

M3 - Article

C2 - 25823907

AN - SCOPUS:84929958667

VL - 151

SP - 47

EP - 55

JO - Drug and Alcohol Dependence

JF - Drug and Alcohol Dependence

SN - 0376-8716

ER -