Disorders - Opioid Use
Neri, S., Bruno, C. M., Pulvirenti, D., Malaguarnera, M., Italiano, C., Mauceri, B., Abate, G., et-al
RATIONALE: Buprenorphine may be a useful alternative option to methadone in addicts. Opioids can produce severe changes in the immune system. OBJECTIVES: The objectives of this study are to compare the effect of sublingual buprenorphine and methadone on the immune system and to compare the two substances on the drying-out program compliance. METHODS: We studied 62 randomized outpatients for a period of 12 months. Subjects (55 males and 7 females; mean age 25+/-4 years; average history of heroin abuse being 2 years) on maintenance treatment were assigned in two groups (A and B). Methadone chloride (medium dose 100 mg/day) was administered to group A, whereas group B received sublingual buprenorphine (32.40+/-2.8 mg/day). Urine toxicological screening, plasma levels of TNF-alpha interleukin-1, interleukin-beta, lymphocyte CD14 and a self-rating depression questionnaire were measured. RESULTS: Urine screening was negative for opiates in 17.6% of group A and in 10.7% of group B (p<0.001; r = 0.62). Depression score was 62+/-2 in group A and 55+/-3 in group B (p < 0.01). Cytokine and CD14 revealed higher concentrations both in groups A and B without significant differences (p > 0.05) between the two groups. CONCLUSIONS: The effects of buprenorphine and methadone tested on the immune system were overlapping in our patients. The elevated cytokine levels observed may suggest that the two drugs stimulate immunologic hyperactivation of an immune system that was formerly inhibited by heroin. Furthermore, our data suggest that buprenorphine can be a valid alternative to methadone in maintenance treatment of chronic heroin abuse and referred a marked decline in depression.
Psychopharmacology, 179(3) : 700-4
- Year: 2005
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Medications used to treat substance abuse
Marsch, Lisa A., Bickel, Warren K., Badger, Gary J., Stothart, Marne E., Quesnel, Kimberly J., Stanger, Catherine, Brooklyn, John
CONTEXT: The prevalence of heroin and other opioid use has markedly increased among adolescents in the last decade; however, virtually no research has been conducted to identify effective treatments for this population. OBJECTIVE: To evaluate the relative efficacy of 2 pharmacotherapies, the partial opioid agonist buprenorphine hydrochloride and the centrally active alpha(2)-adrenergic blocker clonidine hydrochloride, in the detoxification of opioid-dependent adolescents. DESIGN, SETTING, AND PATIENTS: A double-blind, double-dummy, parallel-groups randomized controlled trial conducted in a university-based research clinic from October 2001 to December 2003. Patients were a volunteer sample of 36 adolescents who met DSM-IV criteria for opioid dependence (ages 13-18 years eligible). INTERVENTIONS: Participants were randomly assigned to a 28-day, outpatient, medication-assisted withdrawal treatment with either buprenorphine or clonidine. Both medications were provided along with thrice weekly behavioral counseling and incentives contingent on opiate abstinence. Postdetoxification, all participants were offered the opportunity for continued treatment with the opiate antagonist, naltrexone hydrochloride. MAIN OUTCOME MEASURES: Treatment retention, opiate abstinence, and human immunodeficiency virus risk behavior, along with measures of withdrawal and medication effects. RESULTS: A significantly greater percentage of adolescents who received buprenorphine were retained in treatment (72%) relative to those who received clonidine (39%) (P<.05). For those in the buprenorphine group, a significantly higher percentage of scheduled urine test results were opiate negative (64% vs 32%; P = .01). Participants in both groups reported relief of withdrawal symptoms and drug-related human immunodeficiency virus risk behavior. Those in the buprenorphine condition generally reported more positive effects of the medication. No evidence of opioid intoxication or psychomotor impairment was observed. Sixty-one percent of participants in the buprenorphine condition and 5% of those in the clonidine group initiated treatment with naltrexone. CONCLUSION: Combining buprenorphine with behavioral interventions is significantly more efficacious in the treatment of opioid-dependent adolescents relative to combining clonidine and behavioral interventions.
Archives of General Psychiatry, 62(10) : 1157-64
- Year: 2005
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Medications used to treat substance abuse
Jimenez-Lerma, Juan, Landabaso, Miguel, Iraurgi, Ioseba, Calle, Ricardo, Sanz, Juan, Gutierrez-Fraile, Miguel
Evaluated the use of L-type calcium channel blockers (CaCB) in outpatient opiate detoxification in a controlled trial with sequential allocation of patients to groups. Three groups of individuals subject to opiate detoxification were involved: (1) the experimental group (n=30) received a course of nimodipine and dextropropoxiphen; (2) one control group (n=20) was detoxified with a course of dextropropoxiphen and benzodiazepine; and (3) a second control group (n=30) was treated with a standard course of alpha -2-adrenergic agents and naltrexone. In all cases, the detoxification course was scheduled to last 7 days. All the groups showed a significant opiate withdrawal syndrome (OWS) during detoxification, but from the first day the group treated with CaCB manifested fewer symptoms than the control groups. From the start, the intensity of the OWS was reduced by half in the CaCB group compared with that manifested by the two other groups. The clinical impression of the evolution of the detoxification was that it was comfortable and free of complications (significant side-effects were not observed). The results of the study suggest that the use of calcium channel blockers (CaCB) may be an effective method in opiate detoxification. Full randomized trials are warranted. (PsycINFO Database Record (c) 2007 APA, all rights reserved).
Addiction, 97(7) : 819-824
- Year: 2002
- Problem: Opioid Use
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Medications used to treat substance abuse, Other biological interventions
Krupitsky, E. M., Burakov, A. M., Didenko, T. Y., Romanova, T. N., Grinenko, N. I., Slavina, T. Y., Grinenko, A. Y., et-al
Objective: Soon after termination of withdrawal, many detoxified heroin addiction patients experience affective instability (i.e., depression, dysphoria, anxiety), insomnia, and craving for opiates. Previously, the authors have described these symptoms as the syndrome of anhedonia (SA). The search for novel pharmacologic agents able to optimize treatment of this syndrome is an important component in the prevention of future relapses and stabilization of remissions. This study examines the new pharmacologic treatment of SA. The choice of antidepressants as possible medication for SA is based on the fact that depressive symptoms are the most prominent features of SA. The authors compare the effect of the selective serotonin reuptake inhibitor citalopram on SA with the tricyclic antidepressant amitriptyline and placebo. Methods: Immediately after detoxification, 73 heroin addiction patients were randomly assigned to one of three groups: 26 patients received 20 mg/d citalopram during 3 weeks; 24 patients received 75 mg/d amitriptyline; and 23 patients received placebo. Results: The results of the randomized, single-blind, placebo-controlled study showed that both medications, citalopram and amitriptyline, are more effective than placebo in treatment of SA. However, patients in the amitriptyline group reported a statistically greater number of side effects in comparison with patients in the two other groups. Conclusion: Citalopram significantly reduces the severity of SA in patients with heroin addiction. Copyright copyright 2002 Lippincott Williams & Wilkins, Inc.
Addictive Disorders & their Treatment, 1(1) : 29-33
- Year: 2002
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants, Medications used to treat substance abuse
Guo, S., Jiang, Z., Wu, Y.
Investigated the efficacy of naltrexone in preventing relapse of heroin addiction among Chinese patients after successful detoxification. 302 heroin addicts (aged 16-45 yrs) were enrolled in a double-blind and an open trial conducted in 7 treatment centres for 6 mo. Naltrexone 50 mg/day was given to the Ss in the double-blind study and the dose was titrated from 10 to 50 mg/day in the open trial, based on the Ss' responses. In the double-blind study, 28.57% of naltrexone-treated Ss completed the 6-mo treatment course, while 7.14% of the group receiving placebo remained abstinent. In the open trial, the abstinence rate at 6 mo was 23.6% and the average length of naltrexone treatment was 3.16 mo compared with a previous abstinence rate of 1.2% and drug-free period of 0,5 mo. The non-euphoric effects reported in the naltrexone and placebo groups were 68.18% and 33.3%, respectively. The rate of positive morphine urine tests was 24.38% for the naltrexone-treated group and 40.48% for the placebo recipients. The blocking effect of naltrexone 50 mg/day was more efficient than the medium and low doses given in the open trial. The results suggest that naltrexone is an effective medication for the prevention of relapse for heroin-dependent patients, with only mild side effects. (PsycINFO Database Record (c) 2007 APA, all rights reserved).
Hong Kong Journal of Psychiatry, 11(4) : 2-8
- Year: 2001
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Biological Interventions (any)
, Medications used to treat substance abuse
Hao, W., Zhao, M.
WeiniCom is a Chinese herbal compound. The purposes of this double blind study were to evaluate (1) the efficacy of WeiniCom in reducing acute opioid withdrawal symptoms and craving, and (2) the side effects of WeiniCom, in each instance by comparing WeiniCom with buprenorphine, an established opioid detoxification treatment agent. Forty-two heroin addicts meeting the criteria of dependence in DSM-IV were randomly assigned to two treatment groups: a WeiniCom group (21 cases), and a buprenorphine group (21 cases). The Withdrawal Symptom Rating Scale and the Craving Rating Scale were employed to assess acute withdrawal symptoms and craving for heroin, and the Side Effects Rating Scale was used to measure side effects in the 14-treatment period. Both the WeiniCom and buprenorphine treatments are well-tolerated and very safe. Overall, the relief from opioid withdrawal symptoms and craving was better in the WeiniCom group than in the buprenorphine group. The rate of reduction in the severity of the withdrawal symptoms was faster in the WeiniCom group than in the buprenorphine group. By day nine to 10, the WeiniCom group showed very few withdrawal symptoms. In contrast, from day five on, the buprenorphine group continued to report relatively high scores for withdrawal symptoms and craving. WeiniCom demonstrated positive effects quickly, and required a shorter treatment period to achieve a desired degree of elimination of acute withdrawal symptoms and craving.
Journal of Psychoactive Drugs, 32(3) : 277-84
- Year: 2000
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Medications used to treat substance abuse, Complementary & Alternative Interventions (CAM)
, Homeopathic, plant-based medicines
Fischer, G., Gombas, W., Eder, H., Jagsch, R., Peternell, A., Stuhlinger, G., Pezawas, L., et-al
AIMS: To evaluate the effectiveness of buprenorphine compared with methadone maintenance therapy in opiate addicts over a treatment period of 24 weeks. DESIGN: Subjects were randomized to receive either buprenorphine or methadone in an open, comparative study. SETTING: Subjects were recruited and treated at the drug addiction outpatient clinic at the University of Vienna. PARTICIPANTS: Sixty subjects (19 females and 41 males) who met DSM-IV criteria for opioid dependence and were seeking treatment. INTERVENTION: Subjects received either sublingual buprenorphine (2-mg or 8-mg tablets; maximum daily dose 8 mg) or oral methadone (racemic D -/+ L-methadone; maximum daily dose 80 mg). A stable dose was maintained following the 6-day induction phase. MEASUREMENT: Assessment of treatment retention and illicit substance use (opiates, cocaine and benzodiazepines) was made by urinalysis. FINDINGS: The retention rate was significantly better in the methadone maintained group (p < 0.05) but subjects completing the study in the buprenorphine group had significantly lower rates of illicit opiate consumption (p = 0.04). CONCLUSION: The results support the superiority of methadone with respect to retention rate. However, they also confirm previous reports of buprenorphine use as an alternative in maintenance therapy for opiate addiction, suggesting that a specific subgroup may be benefiting from buprenorphine. This is the first comparative trial to use sublingual buprenorphine tablets: previously published comparison studies refer to 30% solutions of buprenorphine in alcohol.
Addiction, 94(9) : 1337-47
- Year: 1999
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Medications used to treat substance abuse
Timofeev, M. F.
This study examined the influence of acupuncture and an agonist of opiate receptors (Procedol) by means of temperature in both the left and right auricular "Lung" points, and on the coefficient of interhemisphere asymmetry. Twenty heroin dependent patients participated in this research. They were evenly divided into two groups. Both groups consisted of 10 male drug addicts (18-19 years old) who had been using heroin for 8-10 months. Group 1 received 1.0 ml procedol (i.m.). Group 2 were treated with acupuncture. Temperature was measured on the acupuncture points before and after treatment. Results of this study showed that temperature increased on the left and decreased on the right acupuncture points in both the procedol and acupuncture treated groups. The net changes before and after treatment were 92.87% and 92.53% in groups 1 and 2 respectively. The therapeutic effect of acupuncture on treatment of heroin dependence is through the same pathway as the agonist on opiate receptors, 20% of patients are resisted to acupuncture.
American Journal of Chinese Medicine, 27(2) : 143-8
- Year: 1999
- Problem: Opioid Use
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Medications used to treat substance abuse, Complementary & Alternative Interventions (CAM)
, Acupuncture, acupressure
Bertschy, G., Bryois, C., Bondolfi, G., Velardi, A., Budry, P., Dascal, D., Martinet, C., Baettig, D., Baumann, P.
Our clinic has fortuitously developed the therapeutic use of the association of mianserin (maximum daily dose 90 mg) and carbamazepine (maximum daily dose 400 mg) in opiate withdrawal management. If animal studies have suggested efficacy of mianserin in such indication, no human studies have been performed. To test the efficacy of such an association, a comparison was made to clonidine (maximum daily dose 0.600 mg) in a one week treatment period according to a double blind pilot study design. Thirty-two patients were included (16 in each treatment group). The two treatments did not differ in the intensity of the withdrawal, according to the rate of retention in treatment and symptoms, and the psychic distress which were auto-evaluated every other day with the Opiate Withdrawal Questionnaire and several Visual Analog Scales (VAS). The clonidine group, however, scored significantly higher (P < 0.05) on the VAS rating of the global feeling of satisfaction on the last day. The patients in the mianserin group fortuitously had a moderately lower number of daily heroin intakes but there was no significant correlation between this variable and the global OWQ scores on Days 1, 3, 5 and 7. Given the size of the groups, we cannot conclude that the association carbamazepine-mianserin is as effective as clonidine, but a real effectiveness is probable. A study versus placebo would be necessary to draw more definitive conclusions.
Pharmacological Research, 35(5) : 451-6
- Year: 1997
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Tricyclic antidepressants, Anticonvulsants/mood stabilisers (excl. lithium), Medications used to treat substance abuse
Ghodse, H., Myles, J., Smith, S. E.
BACKGROUND. The role of clonidine in the management of opioid-dependent individuals undergoing gradual detoxification. METHOD. A double-blind placebo-controlled trial was conducted on 86 voluntary in-patients (59 male, 27 female) aged 18-47 years, at a specialist drug-dependence treatment unit. Patients entered the trial when on 40 mg of methadone daily or less, and were randomised to receive incremental doses of clonidine (increasing from 0.2 mg daily to 1.2 mg daily) during a 14-day period of gradual methadone detoxification and for four weeks thereafter. Blood pressure was monitored and severity of opioid abstinence was assessed by questionnaire and by clinical examination. RESULT. Half the subjects were withdrawn or defaulted from the trial by the end of two weeks, those receiving clonidine earlier than those receiving dummy medication (9 of the former and only one of the latter because of systemic hypotension). Similar proportions of subjects completed detoxification in the two groups. In those who completed detoxification, clonidine did not significantly reduce either the symptoms or objective signs of opioid withdrawal. CONCLUSIONS. These findings suggest that clonidine has no place as an adjunct to a programme of gradual opioid detoxification.
British Journal of Psychiatry, 165(3) : 370-4
- Year: 1994
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Medications used to treat substance abuse
Lerner, A., Sigal, M., Bacalu, A., Gelkopf, M.
A multicenter prospective open study was performed in order to compare the effectiveness of 2 modalities of individual dynamic psychotherapy in a group of recently detoxified opioid dependent patients. Thirty four patients were assigned to receive either short-term dynamic psychotherapy (ST) or long-term dynamic psychotherapy (LT); both modalities were offered along with drug counselling. At the end of the treatment, the short term therapy group was followed up for 2 years, while the long term therapy group continued the follow up for one year, due to the different time span of the treatment approaches. Dropout rates for ST (47%) and LT (53%) patients were similar, and the re-entry rate for the ST group was superior (62.5% vs. 28.5%). Short term interventions appear to be at least as effective as long term interventions, and have the advantage of a high rate of program re-entry. Further studies conducted on larger samples are needed.
Israel Journal of Psychiatry & Related Sciences, 29(2) : 114-9
- Year: 1992
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Psychodynamic/Psychoanalysis
Vescovi, P. P., Michelini, M., Maninetti, L., Pedrazzoni, M., Pioli, G., Zaniboni, G., Passeri, M.
It has been suggested that the well known analgesic effect of calcitonin (CT) may result from an enhanced secretion of opioid peptides. The purpose of this double-blind, controlled study was therefore to evaluate the effectiveness of CT on the opiate withdrawal syndrome. 20 drug addicts were randomly allocated to receive either 200 UI/day of salmon CT (n = 10) or placebo (n = 10) by nasal spray, after the abrupt withdrawal of low-dose methadone (20 mg/day). The severity of the withdrawal syndrome was evaluated by means of a score derived from a symptom check-list. Plasma beta-endorphin, glucose and insulin levels were measured before and after CT administration. The subjects treated with spray CT had significantly lower score than those treated with placebo. Beta-endorphin levels did not show any significant variation in both groups. An inhibitory action of CT on insulin secretion was observed. Our data suggested that CT might be considered a useful supportive measure for opiate withdrawal. CT action does not seem to involve the opioid system, but is probably mediated by a direct action on specific receptors or by a modulation of noradrenergic pathways.
Recenti Progressi in Medicina, 83(1) : 23-6
- Year: 1992
- Problem: Opioid Use
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Medications used to treat substance abuse, Other biological interventions