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Buprenorphine detoxification treatment for heroin dependence: a preliminary experience in an outpatient setting

Published online by Cambridge University Press:  13 June 2014

Hugh Williams ,
Andrew Remedios ,
Adenekan Oyefeso  and
Jennifer Bennett
Hugh Williams
Affiliation:
Substance Misuse Service, South Downs Health NHS Trust, Brighton BN1 4SF, Honorary Senior Lecturer, Department of Addictive Behaviour and Psychological Medicine, St George's Hospital Medical School, London SW17 ORE, England
Andrew Remedios
Affiliation:
Substance Misuse Service, South Downs Health NHS Trust, Brighton BN1 4SF, England
Adenekan Oyefeso
Affiliation:
Department of Addictive Behaviour and Psychological Medicine, St George's Hospital Medical School, London SW17 ORE, England
Jennifer Bennett
Affiliation:
East Sussex Brighton & Hove Health Authority, 36-38 Friars Walk, Lewes BN7 2PB, England
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Abstract

Objectives: The aim of the study was to evaluate buprenorphine as a detoxification agent for heroin dependence in an outpatient setting. Specifically we sought to establish the rate of completion of detoxification and retention in treatment, the duration of successful detoxification and dose requirements.

Methods: The study was an open prospective evaluation of routinely collected clinical data on the first 60 consecutive heroin dependent patients who underwent buprenorphine detoxification. A flexible dosing regime was adopted with the dose of buprenorphine being adjusted daily against the previous day's withdrawal symptoms.

Results: The majority of patients (40 (67%)) completed detoxification. The median duration of treatment for completers was 17 days (range 9-30 days) with 90% of detoxification episodes completed within 21 days. Patients were commenced on initial median dose of 4mg buprenorphine (range 2mg-6mg) and the median stabilisation dose for the sample was 10mg daily (range 6mg-14mg). The median final dosage of buprenorphine required by patients retained in treatment was 1.2mg (range 0.4mg-2mg). We found older patient age to be a significant predictor of treatment completion.

Conclusions: Buprenorphine was an acceptable and a feasible outpatient detoxification treatment option for heroin dependent patients. Based on the study findings we propose a standard 21-day fixed-dose detoxification schedule.

Keywords

BuprenorphineOpiate dependenceDetoxificationOutpatient
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 19 , Issue 3 , September 2002 , pp. 80 - 83
Copyright
Copyright © Cambridge University Press 2002

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References

1.Reynaud, M, Petit, G, Potard, D, Courty, P. Six deaths linked to concomitant use of buprenorphine and benzodiazepines. Addiction 1999; 93:1385–1392.CrossRefGoogle Scholar
2.Cheskin, LJ, Fudula, PF, Johnson, RE. A controlled comparison of buprenorphine and clonidine for acute detoxication from opioids. Drug Alcohol Dep 1994; 172: 115–121.CrossRefGoogle Scholar
3.O'Connor, JJ, Moloney, E, Travers, R, Campell, A. Buprenorphine abuse among opiate addicts. Br J Addiction 1988; 83:1085–1087.CrossRefGoogle ScholarPubMed
4.Johnson, R, Jaffe, J, Fudala, P. A controlled trial of buprenorphine treatment of opioid dependence. JAMA 1992; 267: 2750–2755.CrossRefGoogle Scholar
5.Gowing, L, Ali, R, White, J. Buprenorphine for the management of opioid withdrawal (Cochrane Review). In: The Cochrane Library, Issue 3, 2000. Oxford: Update Software.Google Scholar
6.O'Connor, PG, Carroll, KM, Shi, JM, Schottenfeld, RS, Kosten, TR, Rounsaville, BJ. Three methods of opiate detoxification in a primary healthcare setting: a randomized trial. Ann Internal Med 1997; 127: 526–530.CrossRefGoogle Scholar
7.Amass, L, Bickel, WK, Higgins, ST, Hughes, JR. A preliminary investigation of outcome following gradual or rapid buprenorphine detoxification. J Addictive Dis 1994; 13: 33–45.CrossRefGoogle ScholarPubMed
8.Bickel, WK, Amass, LHiggins, ST, Badger, GJ, Esch, RA. Effects of adding behavioural treatment to opiate detoxification with buprenorphine. J Consulting Clinical Psychol 1997; 65(5): 803–810.CrossRefGoogle ScholarPubMed
9.AIJ Diamant, K, Fischer, G, Schneider, Cet al.Outpatient opiate detoxification treatment with buprenorphine. Eur Addiction Res 1998; 4(suppl 1): 198–202.CrossRefGoogle Scholar
10.Cameron, D, Allen, D, Galway, K. A pilot study of the effectiveness of buprenorphine and methadone as detoxification agents when choice is given to the consumer. J Substance Use 2001; 6(2): 101–109.CrossRefGoogle Scholar
11.Ghodse, AH. Drugs and Addictive Behaviour: a guide to treatment. Oxford, Blackwell, 1995.Google Scholar
12.Hosmer, D, Lemeshow, S. Applied logistic regression. New York, John Wiley, 1989.Google Scholar
13.Gossop, M, Johns, A, Green, L. Opiate withdrawal, inpatient versus outpatient programmes. BMJ 1986; 293: 103–104.CrossRefGoogle ScholarPubMed
14.Gossop, M, Strang, J. Price, cost and value of opiate detoxification treatments. Br J Psychiatry 2000; 177: 262–266.CrossRefGoogle ScholarPubMed
15.Mattick, R, Hall, W. Are detoxification programmes effective? Lancet 1996; 347: 97–100.CrossRefGoogle ScholarPubMed
16.Vignau, J. Preliminary assessment of a 10 day rapid detoxification programme using high dose buprenorphine. Eur Addiction Res 1998; 4(suppl 1): 29–31.CrossRefGoogle Scholar
17.Shering-Plough, . Dosage guidelines-Subutex, Shering-Plough Ltd. Welwyn Garden City, 1999.Google Scholar
18.Chen, K, Kandel, D. The natural history of drug use from adolescence to the mid-thirties in a general population sample. Am J Public Health 1995; 85: 41–47CrossRefGoogle Scholar