Drug and Alcohol Dependence 2009;99(1-3):28-36. [doi: 10.1016/j.drugalcdep.2008.06.016]
Douglas M. Ziedonis, MD, MPH (Robert Wood Johnson Medical Center, DV Node), Leslie Amass, PhD (Friends Research Institute, PR Node), Marc Steinberg, PhD (Robert Wood Johnson Medical School, DV Node), George E. Woody, MD (University of Pennsylvania, DV Node), Jonathan Krejci, PhD (Mercer Trenton Addiction Science Center, DV Node), Jeffrey J. Annon, MA (Integrated Substance Abuse Programs, UCLA, PR Node), Alan J. Cohen, MA, MFT (Bay Area Addiction Research and Treatment, PR Node), Nancy Waite-O'Brien, PhD (Betty Ford Center, PR Node), Susan M. Stein, MS, RPh (Wayne State University School of Medicine, GL Node), Dennis McCarty, PhD (Oregon Health & Science University, OR/HI Node), Malcolm S. Reid, PhD (NYU School of Medicine, NY Node), Lawrence S. Brown, Jr., MD, MPH (Addiction Research and Treatment Corporation, NY Node), Robert Maslansky, MD (New York University School of Medicine Bellevue Hospital, NY Node), Theresa M. Winhusen, PhD (University of Cincinnati/CinARC, OV Node), Dean Babcock, MSW (Midtown Community Health Center, OV Node), Gregory S. Brigham, PhD (Maryhaven, Inc, OV Node), Joan A. Muir, PhD (Center for Family Studies, U. of Miami, FL Node), Deborah Orr, PhD (Center for Drug-Free Living, FL Node), Betty J. Buchan, PhD (Operation PAR, Inc., FL Node), Terry Horton, MD (Phoenix House, LI Node), Walter Ling, MD (Integrated Substance Abuse Programs, UCLA, PR Node).
Few studies in community settings have evaluated predictors, mediators, and moderators of treatment success for medically supervised opioid withdrawal treatment. This report presents new findings about these factors from a study of 344 opioid-dependent men and women prospectively randomized to either buprenorphine–naloxone or clonidine in an open-label 13-day medically supervised withdrawal study (protocols CTN-0001 and CTN-0002, "Buprenorphine/Naloxone versus Clonidine for Inpatient/Outpatient Opiate Detoxification"). Subjects were either inpatient or outpatient in community treatment settings, but were not randomized by treatment setting. Medication type (buprenorphine–naloxone versus clonidine) was the single best predictor of treatment retention and treatment success, regardless of treatment setting. Compared to the outpatient setting, the inpatient setting was associated with higher abstinence rates but similar retention rates when adjusting for medication type. Early opioid withdrawal severity mediated the relationship between medication type and treatment outcome with buprenorphine–naloxone being superior to clonidine at relieving early withdrawal symptoms. Inpatient subjects on clonidine with lower withdrawal scores at baseline did better than those with higher withdrawal scores; inpatient subjects receiving buprenorphine–naloxone did better with higher withdrawal scores at baseline than those with lower withdrawal scores. No relationship was found between treatment outcome and age, gender, race, education, employment, marital status, legal problems, baseline depression, or length/severity of drug use. Tobacco use was associated with worse opioid treatment outcomes. Severe baseline anxiety symptoms doubled treatment success. Medication type (buprenorphine–naloxone) was the most important predictor of positive outcome; however the paper also considers other clinical and policy implications of other results, including that inpatient setting predicted better outcomes and moderated medication outcomes. (Article (Peer-Reviewed), PDF, English, 2008)
Keywords: Buprenorphine/Naloxone | Clonidine | Effectiveness trials | Opioid dependence| Opioid detoxification | Pharmacological therapy | Suboxone | Drug and
Alcohol Dependence (journal)
Document No: 318, PMID: 18805656, PMCID: PMC2770269
Submitted by CTN Dissemination Librarians, 9/23/2008.