Managing Opioid Withdrawal: How Does Buprenorphine Compare?

Peter M. Yellowlees, MBBS, MD


August 08, 2017

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees. Because of the current opioid epidemic, many patients require managed withdrawal as a necessary step prior to drug-free treatment or as an endpoint of substitution treatment. Now a team of investigators[1] from the University of Adelaide, Australia, has undertaken a systematic review of 27 studies involving 3048 participants to assess the effects of buprenorphine versus tapered doses of methadone, alpha-2-adrenergic agonists, symptomatic medications or placebo, or different buprenorphine regimens for managing opioid withdrawal.

The researchers found that buprenorphine is more effective than clonidine or lofexidine for managing opioid withdrawal and that buprenorphine and methadone appear to be equally effective. However, the data are limited and included divergent studies. It was not possible to draw any conclusions on the relative effectiveness of different rates of tapering the buprenorphine dose.

What does this mean for those involved in addiction treatment? First, it seems that buprenorphine and methadone are still the drugs of choice for treating opiate withdrawal, whether the clinical plan is to aim for abstinence or the institution of naltrexone therapy, or similar. Second, this is an area where a lot more research is required as there is no absolute best approach to managing opiate withdrawal, and we need to keep on learning how best to help our patients.

Thank you for listening to this Medscape Psychiatry Minute. Do enjoy your practice.


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