Longer tapering more effective for prescription opioid addiction

From Clinical Psychiatry News, 23 October 2013:

Longer duration of buprenorphine tapering regime is significantly associated with superior outcomes in treatment for prescription opioid addiction, a double-blind randomized trial has found. The study was published online Oct. 23 in JAMA Psychiatry.

“Our results suggest that a subset of [prescription opioid] abusers may respond favorably to a brief but carefully crafted outpatient treatment involving buprenorphine detoxification, naltrexone maintenance, and behavioral therapy,” wrote Stacey C. Sigmon, Ph.D., of the University of Vermont, Burlington, and her colleagues.

In the trial, 70 prescription opioid–dependent adults aged 18 and older were randomized to 1-, 2-, or 4-week buprenorphine tapering regimes after initial stabilization with buprenorphine and naloxone hydrochloride dihydrate, the investigators reported.

All of the adults met the DSM-IV criteria for opioid dependence. The mean age was 27 years; 35 of the patients (49%) were aged 25 or younger. Patients requiring opioids for pain, pregnant or nursing women, and individuals with significant or unstable psychiatric or medical illnesses were excluded (JAMA Psychiatry 2013 Oct 23 [doi:10.1001/jamapsychiatry.2013.2216]).

Half of patients randomized to the 4-week regime were retained, abstinent, and receiving naltrexone at the end of the study (6-12 weeks after randomization), compared with 17% of patients on the 2-week regime and 21% of patients on the 1-week regime (P = 0.03).

The 4-week taper was associated with fourfold greater odds of favorable treatment response, compared with the 1-week taper (odds ratio 4.1; 95%CI, 1.1-16.0, P = .04) and nearly sixfold greater odds than the 2-week taper (OR 5.9; 95% CI, 1.4-24.7; P = .01), according to the study.

“When percentage of opioid-negative specimens was collapsed across all study visits, the percentage of negative specimens observed in the 4-, 2-, and 1-week conditions was 58% (n = 13), 35% (n = 8), and 38% (n = 9), respectively (P = .07),” Dr. Sigmon reported.

A recent review had suggested a positive association between buprenorphine taper duration and treatment outcomes, but the researchers said there was generally a dearth of empirical data on treatments for prescription opioid dependence. Read more.

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