Kelly E Dunn1, Kathryn A Saulsgiver2, Mollie E Miller3, Paul A Nuzzo4, Stacey C Sigmon5. 1. Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, United States. Electronic address: kdunn9@jhmi.edu. 2. University of Pennsylvania School of Medicine, Philadelphia, PA, United States. 3. Brown University Center for Alcohol and Addiction Studies, Providence, RI, United States. 4. Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States. 5. University of Vermont Departments of Psychiatry, Burlington, VT, United States; University of Vermont Departments of Psychology, Burlington, VT, United States.
Abstract
BACKGROUND: Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification. METHODS: This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatient buprenorphine tapers among primary prescription opioid (PO) abusers. The aim is to characterize the time course and severity of buprenorphine withdrawal under rigorous, double-blind conditions, across multiple taper durations, and using multiple withdrawal-related measures (i.e., self-report and observer ratings, pupil diameter, ancillary medication utilization). Participants were PO-dependent adults undergoing buprenorphine detoxification and biochemically-verified to be continuously abstinent from opioids during their taper (N = 28). RESULTS: Participants randomly assigned to the 4-week taper regimen experienced a relatively mild and stable course of withdrawal, with few peaks in severity. In contrast, the 1- and 2-week taper groups experienced stark increases in withdrawal severity during the week following the last buprenorphine dose, followed by declines in withdrawal severity thereafter. The 4-week taper group also reported significantly fewer disruptions in sleep compared to the other experimental groups. When predictors of withdrawal were examined, baseline ratings of "Expected Withdrawal Severity" was the most robust predictor of withdrawal experienced during the taper. CONCLUSION: Data from this trial may inform clinicians about the expected time course, magnitude, and pattern of buprenorphine withdrawal and aid efforts to identify patients who may need additional clinical support during outpatient buprenorphine detoxification.
RCT Entities:
BACKGROUND: Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification. METHODS: This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatientbuprenorphine tapers among primary prescription opioid (PO) abusers. The aim is to characterize the time course and severity of buprenorphine withdrawal under rigorous, double-blind conditions, across multiple taper durations, and using multiple withdrawal-related measures (i.e., self-report and observer ratings, pupil diameter, ancillary medication utilization). Participants were PO-dependent adults undergoing buprenorphine detoxification and biochemically-verified to be continuously abstinent from opioids during their taper (N = 28). RESULTS:Participants randomly assigned to the 4-week taper regimen experienced a relatively mild and stable course of withdrawal, with few peaks in severity. In contrast, the 1- and 2-week taper groups experienced stark increases in withdrawal severity during the week following the last buprenorphine dose, followed by declines in withdrawal severity thereafter. The 4-week taper group also reported significantly fewer disruptions in sleep compared to the other experimental groups. When predictors of withdrawal were examined, baseline ratings of "Expected Withdrawal Severity" was the most robust predictor of withdrawal experienced during the taper. CONCLUSION: Data from this trial may inform clinicians about the expected time course, magnitude, and pattern of buprenorphine withdrawal and aid efforts to identify patients who may need additional clinical support during outpatientbuprenorphine detoxification.
Authors: Jennifer R Havens; Michelle R Lofwall; Simon D W Frost; Carrie B Oser; Carl G Leukefeld; Richard A Crosby Journal: Am J Public Health Date: 2012-11-15 Impact factor: 9.308
Authors: Andrew Rosenblum; Charles M Cleland; Chunki Fong; Deborah J Kayman; Barbara Tempalski; Mark Parrino Journal: J Environ Public Health Date: 2011-07-06
Authors: Zoe M Weinstein; Gabriela Gryczynski; Debbie M Cheng; Emily Quinn; David Hui; Hyunjoong W Kim; Colleen Labelle; Jeffrey H Samet Journal: Drug Alcohol Depend Date: 2018-06-19 Impact factor: 4.492
Authors: Kelly E Dunn; Andrew S Huhn; Cecilia L Bergeria; Cassandra D Gipson; Elise M Weerts Journal: J Pharmacol Exp Ther Date: 2019-08-07 Impact factor: 4.030
Authors: Michael D Stein; Micah T Conti; Debra S Herman; Bradley J Anderson; Genie L Bailey; Donnell Van Noppen; Ana M Abrantes Journal: Am J Addict Date: 2019-04-16