Abstract
IntroductionThe United States has been battling an opioid epidemic for decades. As substance use disorders have grown, so too has investigation into treatment options, including integrative medicine approaches, for managing opioid withdrawal symptoms (OWS). ObjectivesThis systematic review sought to assess the use of integrative medicine approaches for the alleviation of OWS in patients dependent on opioids and to summarize the available data. MethodsThe authors searched using synonyms for opioids, substance use disorder, and integrative medicine and standardized searches in Embase, PubMed, and Cochrane Library. We also hand searched references for systematic reviews. This review did not include articles that could not be obtained as full-text publications via interlibrary loan. The review also excluded studies with interventions involving acupuncture because multiple systematic reviews on this approach already exist. In addition, we also excluded studies of therapy for opioid maintenance. We evaluated studies for inclusion based on the Jadad criteria. We compared opioid withdrawal outcomes of the studies to determine the efficacy of integrative medicine approaches. ResultsThe authors identified a total of 382 unique publications initially for possible inclusion through systematic searches. After applying inclusion and exclusion criteria, five studies met Jadad criteria. The authors identified an additional two studies for inclusion via hand searching. A total of seven studies included interventions consisting of passionflower, weinicom, fu-yuan pellet, jinniu capsules, tai-kang-ning, dynorphin, and l-tetrahydropalmatine. Analyzing the articles was difficult given the varied scoring methods they used to quantify opioid withdrawal symptoms and the small sample sizes in the trials. Most showed evidence that supported integrative medicine approaches for OWS, although the strength of evidence was limited because of sample sizes. ConclusionsThis review found evidence of multiple integrative medicine approaches for opioid withdrawal symptoms. Well-designed randomized controlled trials should assess the efficacy of integrative medicine for improvement in OWS.
Highlights
The United States has been battling an opioid epidemic for decades
Well-designed randomized controlled trials should assess the efficacy of integrative medicine for improvement in opioid withdrawal symptoms (OWS)
1.0 Introduction: In 2017, 191 million opioid prescriptions were written in the United States, the first time in ten years that the number of prescriptions written for opioids has been below 200 million per year.[1]
Summary
As substance use disorders have grown, so too has investigation into treatment options, including integrative medicine approaches, for managing opioid withdrawal symptoms (OWS). Opioid withdrawal symptoms (OWS), including agitation, insomnia, diaphoresis, tachycardia, and many others, can be debilitating for many patients.[2,3] Symptoms can start as early as six hours after the last dose of an opioid and peak around 72 hours after last use.[2] OWS may not be life-threatening, unassisted withdrawal can increase the risk of relapse.[2]
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