Treatment of polydrug-using opiate dependents during withdrawal: towards a standardisation of treatment

Øistein Kristensen, Terje Lølandsmo, Ase Isaksen, John-Kåre Vederhus, Thomas Clausen, Øistein Kristensen, Terje Lølandsmo, Ase Isaksen, John-Kåre Vederhus, Thomas Clausen

Abstract

Background: The growing tendency among opioid addicts to misuse multiple other drugs should lead clinicians and researchers to search for new pharmacological strategies in order to prevent life-threatening complications and minimize withdrawal symptoms during polydrug detoxification.

Methods: A non-randomised, open-label in-patient detoxification study was used to compare the short-time efficacy of a standardised regimen comprising 6 days Buprenorphine and 10 days Valproate (BPN/VPA) (n = 12) to a control group (n = 50) who took a 10-day traditional Clonidine/Carbamazepine (CLN/CBZ) regimen. Sixty-two dependent subjects admitted to a detoxification unit were included, all dependent on at least opioids and benzodiazepines. Other dependencies were not excluded.

Results: In the BPN/VPA group, 8 out of 12 patients (67%) completed treatment compared with 25 of 50 patients (50%) in the CLN/CBZ group; this difference between the groups was non-significant (p = 0.15). Withdrawal symptoms were reduced in both groups, but only the BPN/VPA group achieved a reduction in withdrawal symptoms from day one. The difference between the two groups was significantly in favour of the BPN/VPA group for days 2 (p < 0.001), 3 (p < 0.05), 4 (p < 0.001), 5 (p < 0.01), 7 (p < 0.01) and 8 (p < 0.05). The BPN/VPA combination did not affect blood pressure, pulse or liver function, and the total burden of side-effects was experienced as modest. There appeared to be no pharmacological interactions of clinical concern, based on measurement of Buprenorphine and Valproate serum levels. Both the patients and the staff were satisfied with the standardised treatment combination.

Conclusion: Overall, the combination of Buprenorphine and Valproate seems to be a safe and promising method for treating multiple drug withdrawal symptoms. The results of this study suggest that the BPN/VPA combination is potentially a better detoxification treatment for polydrug withdrawal than the traditional treatment with Clonidine and Carbamazepine. However, a randomised, double-blind study with a larger sample size to confirm our results is recommended.

Trial registration: ClinicalTrials.gov NCT00367874.

Figures

Figure 1
Figure 1
Proportion of patients retained in treatment. Kaplan-Meyer analysis. Log rank test p = 0.15. Buprenorphine/Valproate group (BPN/VPA) n = 12, and Clonidine/Carbamazepine group (CLN/CBZ) n = 50.
Figure 2
Figure 2
Opiate Withdrawal Symptoms during treatment with Clonidine/Carbamazepine (CLN/CBZ) n = 50, and Buprenorphine/Valproate (BPN/VPA) n = 12. Mean change in SOWS score from baseline. Lower score indicates fewer withdrawal symptoms. * p

Figure 3

Daily measurement of blood pressure…

Figure 3

Daily measurement of blood pressure and pulse for the Buprenorphine/Valproate group (n =…

Figure 3
Daily measurement of blood pressure and pulse for the Buprenorphine/Valproate group (n = 12).
Figure 3
Figure 3
Daily measurement of blood pressure and pulse for the Buprenorphine/Valproate group (n = 12).

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Source: PubMed

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