Naltrexone shortened opioid detoxification with buprenorphine

Annie Umbricht, I. D. Montoya, D. R. Hoover, K. L. Demuth, C. T. Chiang, K. L. Preston

Research output: Contribution to journalArticle

Abstract

This double-blind, randomized, placebo-controlled clinical trial evaluated the impact on withdrawal symptoms of (i) combining naltrexone with a 4-day buprenorphine taper for short opioid detoxification (NB Group), compared to (ii) using a 4-day buprenorphine taper alone, followed by naltrexone on day 8 (PB Group). Sublingual buprenorphine was administered on days 1-4 (26 mg total). For the NB Group (n=32) escalating doses of oral naltrexone were given on days 2-8 (placebo day 1). For the PB Group (n=28) placebo was given on days 1-7 and naltrexone on day 8. Main outcome measures were Observed Opioid Withdrawal scores (OOW, 0-30) and use of medications to treat opioid withdrawal. Of 32 patients in the NB group, 59% experienced clinically relevant withdrawal (defined as OOW≥5) on day 2, but, after day 5, none experienced withdrawal. In the PB group, the number of patients experiencing withdrawal increased over time. The first naltrexone dose induced comparable withdrawal in both groups: peak OOW scores were (mean±SD) 5.2±3.3 on day 2 for the NB group, and 4.0±3.9 on day 8 for the PB group (NS), though, on day 2, 7 patients dropped out in the NB group and none in the PB group, while only one patient dropped out in the PB group on day 8. Throughout the 8-day study, patients in both groups received similar amount of adjunct medication: 0.64±0.07 mg (NB group) of clonidine vs 0.73±0.15 mg (PB group; NS). Only 25% of patients required use of sedatives (up to 20 mg diazepam). Starting naltrexone on day 2 appeared to abolish withdrawal symptoms after day 5 and, thus, to shorten the duration of withdrawal symptoms. Peak withdrawal symptoms after naltrexone were of moderate intensity, suggesting that naltrexone combined with buprenorphine is an acceptable and safe treatment for shortened opioid detoxification and induction of naltrexone maintenance. Copyright (C) 1999 Elsevier Science Ireland Ltd.

Original languageEnglish (US)
Pages (from-to)181-190
Number of pages10
JournalDrug and Alcohol Dependence
Volume56
Issue number3
DOIs
StatePublished - Oct 1 1999

Fingerprint

Buprenorphine
Detoxification
Naltrexone
Opioid Analgesics
withdrawal
Substance Withdrawal Syndrome
Group
Placebos
Clonidine
Diazepam
Hypnotics and Sedatives
medication
Randomized Controlled Trials
Outcome Assessment (Health Care)
induction

Keywords

  • Buprenorphine
  • Naltrexone
  • Opioid dependence
  • Opioid Detoxification
  • Treatment

ASJC Scopus subject areas

  • Medicine(all)
  • Behavioral Neuroscience
  • Toxicology
  • Health(social science)

Cite this

Umbricht, A., Montoya, I. D., Hoover, D. R., Demuth, K. L., Chiang, C. T., & Preston, K. L. (1999). Naltrexone shortened opioid detoxification with buprenorphine. Drug and Alcohol Dependence, 56(3), 181-190. https://doi.org/10.1016/S0376-8716(99)00033-2

Naltrexone shortened opioid detoxification with buprenorphine. / Umbricht, Annie; Montoya, I. D.; Hoover, D. R.; Demuth, K. L.; Chiang, C. T.; Preston, K. L.

In: Drug and Alcohol Dependence, Vol. 56, No. 3, 01.10.1999, p. 181-190.

Research output: Contribution to journalArticle

Umbricht, A, Montoya, ID, Hoover, DR, Demuth, KL, Chiang, CT & Preston, KL 1999, 'Naltrexone shortened opioid detoxification with buprenorphine', Drug and Alcohol Dependence, vol. 56, no. 3, pp. 181-190. https://doi.org/10.1016/S0376-8716(99)00033-2
Umbricht, Annie ; Montoya, I. D. ; Hoover, D. R. ; Demuth, K. L. ; Chiang, C. T. ; Preston, K. L. / Naltrexone shortened opioid detoxification with buprenorphine. In: Drug and Alcohol Dependence. 1999 ; Vol. 56, No. 3. pp. 181-190.
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