Disorders - Opioid Use
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
Pini, L. A., Sternieri, E., Ferretti, C.
The activity of dapiprazole, clonidine and a placebo were studied to reduce abstinence symptoms and modify the psychological outline
during a withdrawal period in heroin addicts. Forty heroin addicts were treated in a double-blind design and, within two weeks, relapse in heroin use
was higher in the placebo group (8/10) in comparison with the dapiprazole (1/20) and clonidine (0/10) groups. During treatment clonidine was able to
reduce depression and paranoid-ideas scores, whereas dapiprazole reduced depression, anxiety, hostility, phobic anxiety, obsessiveness and
psychoticism. Side-effects were mild and it may be concluded that both dapiprazole and clonidine are effective and safe drugs for the treatment of
opiate withdrawal syndrome.
International Journal of Clinical Pharmacology Research, 11(2) : 99-
105
- Year: 1991
- Problem: Opioid Use
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Medications used to treat substance abuse
San, L., Cami, J., Peri, J. M, Mata, R., Porta,
M.
The efficacy of clonidine, methadone, and guanfacine in rapid detoxification of heroin inpatients was assessed in a randomized
controlled clinical trial. Signs and symptoms of abstinence and of side effects were analysed in 90 heroin addicts successfully completing a 12-day
inpatient trial. All patients fit DSM-III criteria for opioid dependence, the age range being 18 to 36 years. All three drugs were effective in
controlling abstinence; however, the course of abstinence was different in the methadone group as compared to the adrenergic agonists, the latter
showing limitations in their ability to suppress withdrawal manifestations. While mean number of withdrawal signs and symptoms was significantly
lower during days 2 to 5 in the methadone group (p less than 0.01), adrenergic agonists were slightly more effective at the end of the trial.
Incidence of side effects was closely related to the dose administered. Hypotensive action of adrenergic agonists was more marked in orthostatic
position. The present results suggest that methadone is superior to adrenergic agonists. Between these drugs clonidine appears to be less effective
than guanfacine in controlling some withdrawal manifestations, and causes more side effects, mainly of cardiovascular nature.
British Journal of Addiction, 85(1) : 141-
7
- Year: 1990
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Medications used to treat substance abuse
San, L., Cami, J., Peri, J. M., Mata,
R., Porta, M.
Predictors of either detoxification
success or failure were evaluated during an inpatient trial that compared the efficacy of methadone, clonidine and guanfacine for rapid heroin
detoxification. The analysis of such predictors was stimulated by the fact that in order to achieve 90 patients who completed the study (30 in each
group), a total of 170 patients had to be included. Of 80 detoxification failures, 10 occurred in the methadone group, 32 in the guanfacine group,
and 38 in the clonidine group. Voluntary request for discontinuation of the detoxification schedule was the first cause of failure. There were not
statistically significant differences with regard to sociodemographic characteristics and pattern of drug consumption among patients in the three
groups who completed detoxification with success or failure. The treatment drug, the type of schedule and the score obtained from the Symptom
Checklist-90/Revised (SCL-90/R) were the only predictors of either detoxification success or failure. Inpatient opioid detoxification would be a
useful strategy for patients with more severe psychological symptoms.
British Journal of
Addiction, 84(1) : 81-7
- Year: 1989
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Medications used to treat substance abuse
Drummond, D. C., Turkington, D., Rahman, M. Z., Mullin, P. J., Jackson, P.
A double blind trial of chlordiazepoxide vs. methadone in the management of the opiate withdrawal syndrome
was conducted in a group of 24 regular heroin takers. Subjective and objective measures including physiological parameters were recorded to compare
the severity of opiate withdrawal between the two groups. No significant difference was found in terms of subjective withdrawal distress between the
two treatment conditions, although there was a tendency to a return of withdrawal symptoms in the methadone group towards the end of treatment. A
nurse rating scale demonstrated a significantly higher level of withdrawal signs in the chlordiazepoxide group on day 3. Physiological measures
suggested that neither group experienced a severe withdrawal illness. A similar number in each group (37%) became completely drug free.
Drug & Alcohol Dependence, 23(1) : 63-
71
- Year: 1989
- Problem: Opioid Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Anxiolytics including benzodiazepines, Medications used to treat substance abuse