TY - JOUR
T1 - Characterizing opioid withdrawal during double-blind buprenorphine detoxification
AU - Dunn, Kelly E.
AU - Saulsgiver, Kathryn A.
AU - Miller, Mollie E.
AU - Nuzzo, Paul A.
AU - Sigmon, Stacey C.
N1 - Funding Information:
Preparation of this manuscript was supported in part by National Institutes of Health research ( R01DA019989 , Sigmon; R34DA037385 , Sigmon; R01DA035246 , Dunn; R21DA035327 , Dunn) and training ( T32DA007242 ) grants, as well as a National Institute of General Medical Sciences center grant ( P20GM103644 ).
Publisher Copyright:
© 2015 Elsevier Ireland Ltd.
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
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U2 - 10.1016/j.drugalcdep.2015.02.033
DO - 10.1016/j.drugalcdep.2015.02.033
M3 - Article
C2 - 25823907
AN - SCOPUS:84929958667
SN - 0376-8716
VL - 151
SP - 47
EP - 55
JO - Drug and alcohol dependence
JF - Drug and alcohol dependence
ER -