Longer Taper May Boost Abstinence Rates in Opioid Abusers

Caroline Cassels

October 25, 2013

A 4-week buprenorphine taper plus naltrexone maintenance treatment may boost abstinence rates in patients who abuse prescription opioids (POs).

A double-blind, randomized clinical trial showed that 50% of patients assigned to a 4-week taper were abstinent at the end of the 12-week period compared with 17% and 21% in the 2- and 1-week groups, respectively.

"These results suggest that the duration of taper influences treatment outcome and are consistent with prior studies showing favorable outcomes with longer- vs briefer-duration detoxification," the authors, led by Stacey Sigmon, PhD, University of Vermont in Burlington, write.

The study was published online October 23 in JAMA Psychiatry.

Growing Problem

The investigators note that abuse of POs, including oxycodone, hydrocodone, and hydromorphone, is a major and growing public health concern in the United States.

It is estimated that costs related to abuse of POs, including emergency department visits, overdoses, criminal activity, and psychiatric and medical consequences, total $8 billion annually.

"Despite this, there is a dearth of empirical information regarding treatments for PO dependence," the authors write.

Agonist maintenance is the recommended treatment for the majority of opioid-dependent patients, but the researchers note that detoxification also represents an important treatment option that should be considered.

Investigators evaluated an outpatient detoxification program in a 2-phase, 12-week clinical trial in an outpatient research clinic with 70 PO-dependent patients.

After a 2-week period of taking buprenorphine, patients were randomly assigned to taper the drug during a period of 1 (n = 24), 2 (n = 24), or 4 (n = 24) weeks, followed by naltrexone therapy. All patients received behavioral therapy.

Higher Abstinence Rate

The researchers found that opioid abstinence was greater with the 4-week taper than with the 1- and 2-week tapers.

"The amounts of abstinence achieved in the present study are generally greater than those seen in prior studies of outpatient detoxification...," the investigators write.

There are several potential explanations for this, they note, including the fact that the behavioral therapy was more intensive than the counseling used in a previous study.

The study's findings, the authors write, suggest that some PO abusers may respond favorably to outpatient treatment with buprenorphine detoxification followed by naltreaxone against a backdrop of behavioral therapy.

"Additional controlled studies are needed to better understand the parameters of efficacious treatment for PO dependence, as well as to identify the individuals for whom brief vs longer-term treatments are warranted," they conclude.

Dr. Sigmon reports that she has received consulting payments from Alkermes and that she has received through her university research support from Titan Pharmaceutical. The disclosures of the remaining authors are listed in the original study.

JAMA Psychiatry. Published online October 23, 2013. Abstract

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