Role of Medication and Background Variables in Dropout from Opiate Withdrawal Treatment Â– A Retrospective Chart Review

Hakansson A Medvedeo A

doi:10.4172/2329-6488.1000199

Abstract

The present study aimed to examine whether retention in inpatient opiate detoxification was affected by the introduction of buprenorphine as a standard medication in opiate withdrawal, compared to older substances, when controlling for previous dropouts from detoxification, age, gender and current aftercare treatment planning. This chart review with a naturalistic design studied all inpatient opiate detoxifications in a detoxification unit during five years. In total, 375 patients with a total of 639 detoxification episodes were studied, with the withdrawal medication prescribed being buprenorphine, clonidine, dextropropoxyphene or methadone. In logistic regression, using buprenorphine as reference, completion of detoxification was unrelated to the choice of medication, but associated with the presence of an aftercare plan upon admission, older age and a lower number of previous dropouts. However, dropouts remained significantly longer until dropout with buprenorphine, compared to clonidine and dextropropoxyphene. While the longer time to dropout suggests a higher effectiveness in withdrawal treatment with buprenorphine, no overall effect was seen on actual dropout rates. Lack of an aftercare plan and previous dropouts may be risk factors of dropout in opiate detoxification.

Highlights

Withdrawal treatment is a common procedure in the treatment of heroin-dependent patients coming off heroin or attempting to facilitate entry into psychosocial treatment or other interventions not involving opiate substitution treatment
Completion of detoxification was significantly associated with a pretreatment aftercare planning, older age, and fewer previous dropouts (Tables 4 and 5)
The study rather demonstrated that the presence of an aftercare plan upon admission may be associated with a higher retention rate, and that dropout was predicted by previous dropouts from inpatient detoxification

Summary

Introduction

Withdrawal treatment (often referred to as detoxification) is a common procedure in the treatment of heroin-dependent patients coming off heroin or attempting to facilitate entry into psychosocial treatment or other interventions not involving opiate substitution treatment. Pharmacological treatment during opiate detoxification may involve an opioid, achieving cross-tolerant treatment, or other symptom-oriented treatment such as alpha2-adrenergic agonists [2]. Alpha-2-adrenergic agonists, e.g. clonidine, lofexidine or guanfacine, have demonstrated some relative effectiveness in opiate withdrawal. The use of clonidine, may be somewhat limited by side effects including hypotension [2,3]. Dextropropoxyphene has been used in some settings for detoxification purposes, but the use of higher doses is limited by side effects [2]. Before being withdrawn from the market, dextropropoxyhene has been used for opiate detoxification in some settings, both according to older publications [6], and in somewhat more recent years in Spain [7] and Sweden [8], little has been documented about its efficacy

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