Article type
Year
Abstract
Objectives: To provide an overview of the reviews focused on treatments for opioid withdrawal.
Methods: Results are summarised across the reviews for homogeneous comparisons and outcomes.
Results: The total number of studies included in the original reviews is 37, with a total of 2498 participants (range 20 - 200) and 43 comparisons: 12 tapered methadone versus adrenergic agonists; 2 tapered methadone versus other opiod agonists, 6 different modalities of methadone detoxification programs, 4 buprenorphine versus adrenergic agonists, 5 different adrenergic agonists, 3 adrenergic agonists versus naltrexone , and 2 adrenergic agonists with placebo. The remaining 9 were single comparisons which could not be summarised. The outcomes were: withdrawal symptoms, retention in treatment, completion rate, relapse rate, side effects.
Results on withdrawal symptoms could not be summarised because the studies used different and not comparable scales; results on urinalysis as well could not be summarised because they are differently reported and mainly based on tests rather than patients.
Tapered doses of methadone are more effective than adrenergic agonists for retention in treatment [RR 1.51, 95% CI 1.00 -2.27], completion of withdrawal [RR 1.26 95% CI 1.06 -1.49], completion rate [RR 1.11 95% CI 0.85 -1.43] and relapse rate [RR 1.25 95% CI 1.00 -1.56]. Methadone controlled early withdrawal symptoms more adequately than adrenergic agonists. When compared with opioid agonists, methadone is more effective on completion rate and withdrawal symptoms. Improvements in the methadone withdrawal response could be achieved trough more information, counselling, and a combination of contingent payment with verbal feedback. Buprenorphine appears to have an advantage over clonidine avoiding the side effect of hypotension; there are no significant differences in any parameter for withdrawal managed with lofexidine compared to clonidine.. The results of completion rate are in favour of the treatment clonidine +naltrexone [RR 1,22 95% CI 0.98 -1, 51] versul clonidine alone. Patiens treated with adrenergic agonists have less withdrawal symptoms and higher rates of completion than subjects treated with placebo.
Conclusions: Despite a considerable number of trials have been carried out on this topic, only a few can be incorporated in a pooled quantitative analysis because of a great heterogeneity. One of the most important outcome, the withdrawal symptoms and signs could not be analysed because of the great variability of the scales used in the primary studies and of the way in which results are reported. The same problem applies to urine test results. Findings from this overview suggest that methadone detoxification has higher completion of withdrawal and retention in treatment and less side effects compared with other treatments. However, other important outcomes could be considered only narratively. The following step could be to define which other relevant research questions should be addressed, and which is the most appropriate study design to answer these questions.
Methods: Results are summarised across the reviews for homogeneous comparisons and outcomes.
Results: The total number of studies included in the original reviews is 37, with a total of 2498 participants (range 20 - 200) and 43 comparisons: 12 tapered methadone versus adrenergic agonists; 2 tapered methadone versus other opiod agonists, 6 different modalities of methadone detoxification programs, 4 buprenorphine versus adrenergic agonists, 5 different adrenergic agonists, 3 adrenergic agonists versus naltrexone , and 2 adrenergic agonists with placebo. The remaining 9 were single comparisons which could not be summarised. The outcomes were: withdrawal symptoms, retention in treatment, completion rate, relapse rate, side effects.
Results on withdrawal symptoms could not be summarised because the studies used different and not comparable scales; results on urinalysis as well could not be summarised because they are differently reported and mainly based on tests rather than patients.
Tapered doses of methadone are more effective than adrenergic agonists for retention in treatment [RR 1.51, 95% CI 1.00 -2.27], completion of withdrawal [RR 1.26 95% CI 1.06 -1.49], completion rate [RR 1.11 95% CI 0.85 -1.43] and relapse rate [RR 1.25 95% CI 1.00 -1.56]. Methadone controlled early withdrawal symptoms more adequately than adrenergic agonists. When compared with opioid agonists, methadone is more effective on completion rate and withdrawal symptoms. Improvements in the methadone withdrawal response could be achieved trough more information, counselling, and a combination of contingent payment with verbal feedback. Buprenorphine appears to have an advantage over clonidine avoiding the side effect of hypotension; there are no significant differences in any parameter for withdrawal managed with lofexidine compared to clonidine.. The results of completion rate are in favour of the treatment clonidine +naltrexone [RR 1,22 95% CI 0.98 -1, 51] versul clonidine alone. Patiens treated with adrenergic agonists have less withdrawal symptoms and higher rates of completion than subjects treated with placebo.
Conclusions: Despite a considerable number of trials have been carried out on this topic, only a few can be incorporated in a pooled quantitative analysis because of a great heterogeneity. One of the most important outcome, the withdrawal symptoms and signs could not be analysed because of the great variability of the scales used in the primary studies and of the way in which results are reported. The same problem applies to urine test results. Findings from this overview suggest that methadone detoxification has higher completion of withdrawal and retention in treatment and less side effects compared with other treatments. However, other important outcomes could be considered only narratively. The following step could be to define which other relevant research questions should be addressed, and which is the most appropriate study design to answer these questions.