Podcast: Buprenorphine for managing opioid withdrawal

The Cochrane Drugs and Alcohol Group oversees the reviews of interventions to help people with alcohol and other drug problems. In February 2017, their review of the use of buprenorphine for managing opioid withdrawal was updated by Linda Gowing from the University of Adelaide in Australia and her colleagues. Linda describes the latest findings in this podcast.

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John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. The Cochrane Drugs and Alcohol Group oversees the reviews of interventions to help people with alcohol and other drug problems. In February 2017, their review of the use of buprenorphine for managing opioid withdrawal was updated by Linda Gowing from the University of Adelaide in Australia and her colleagues. Linda describes the latest findings in this podcast.

Linda: People who are dependent on opiates such as heroin, oxycontin or morphine, need to undergo withdrawal as a first step to longer-term treatment. Although withdrawal from opioid drugs is not usually life-threatening, uncomfortable symptoms and intense craving make it difficult for most people. Approaches to the management of opioid withdrawal involve either the use of non-opioid medications to reduce the signs and symptoms of withdrawal, or the use of opioid medications to suppress withdrawal, with doses of these medications then reduced over a short period of time.
We examined the use of buprenorphine for managing opioid withdrawal. Buprenorphine is a partial opioid agonist, with enough morphine-like properties to suppress the physical signs and symptoms of withdrawal. We found 26 studies that met our criteria for the review. More than half the studies compared buprenorphine with clonidine or lofexidine, which are the main non-opioid medications used for opioid withdrawal. There were also 6 studies of buprenorphine versus methadone, the other opioid medication that is often used in the treatment of opioid dependence; and another six that compared different rates of reduction of the buprenorphine dose.
The moderate quality evidence from the 14 trials that compared buprenorphine against clonidine or lofexidine shows that buprenorphine was more effective, in terms of severity of withdrawal, duration of withdrawal treatment and the likelihood of completion of treatment. The results suggest that for every four people treated with buprenorphine, one more person can be expected to complete treatment than would be the case with clonidine or lofexidine.
Buprenorphine and methadone appear to be equally effective for opioid withdrawal, but data are limited. Both drugs are also effective for longer-term substitution therapy, if the person finds it too difficult to achieve abstinence. 
Finally, it’s not possible to draw conclusions from the available evidence on the relative effectiveness of different rates of reduction of the dose of buprenorphine. The studies had markedly different findings, suggesting that there may be multiple factors affecting the response to the rate of dose reduction.

John: If you would like to find more about this evidence base for buprenorphine in the management of opioid withdrawal, just go online to Cochrane Library dot com and search ‘buprenorphine for opioid withdrawal’.

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