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Slower tapering of prescription opioids is most successful

Abstinence more likely after 4-week tapering than quicker regimens

Louise Prime

Thursday, 24 October 2013

People addicted to prescription opioids are more likely to be abstinent after a four-week tapering outpatient programme followed by naltrexone therapy than after one-week or two-week reduction programmes, research has shown.

The researchers, from the US, found that little investigation had been done into the best treatment for the abuse of prescribed opioids, such as oxycodone, hydrocodone and hydromorphone, which they describe as a significant public health problem. They set out to evaluate outpatient detoxification treatment using buprenorphine and naltrexone over various tapering regimens.

For their 12-week study, published today in JAMA Psychiatry, they recruited 70 people who were dependent on prescription opioids.

All participants initially had two weeks’ treatment with buprenorphine, then they were randomised to taper the buprenorphine dose over four weeks, two weeks or one week, followed by naltrexone therapy. People in all three groups were also supported with behavioural therapy, and also had their urine tested throughout the trial.

Patients who had undergone the slower, four-week regimen were more likely to be abstinent from opioids than those who had been allocated to either of the quicker tapering regimens. Five weeks after randomisation, 63% of people in the 4-week programme were abstinent compared with 29% of those in the two- and one-week tapering groups; 12 weeks after randomisation the proportions abstinent were 50%, 16% and 20% respectively.

The study’s authors say their results suggest that some people who abuse prescription opioids may respond well to an outpatient programme of buprenorphine detoxification followed by naltrexone treatment, when they are also supported by behavioural therapy.

They conclude: “Additional controlled studies are needed to better understand the parameters of efficacious treatments for PO dependence, as well as to identify the individuals for whom brief vs. longer-term treatments are warranted.”

doi:10.1001/jamapsychiatry.2013.2216

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