Two methods of community detoxification from opiates: an open-label comparison of lofexidine and buprenorphine.

There is currently no consensus on the best approach to the management of opiate detoxification. In the current open-label study, 69 opiate-dependent individuals requesting outpatient detoxification were allocated to two different medication regimes: lofexidine and buprenorphine. Allocation was dependent on the timing of their presentation. Lofexifidine is a structural analogue of clonidine, and used widely in the UK. Buprenorphine is a partial opiate agonist with unusual pharmacological properties. Outcomes were better for the buprenorphine-receiving group (n=38). Clients receiving buprenorphine had a less severe withdrawal syndrome, and were more likely to complete their detoxification. In addition, for the buprenorphine-receiving group it was found that the withdrawal syndrome was least in those prescribed an initial dose of 4 mg. The findings and their implications are discussed. The design of the study precludes definitive conclusions regarding relative efficacy.