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Buprenorphine and buprenorphine/naloxone (Suboxone) play major roles in detoxification from prescription opioids (as well as illicit narcotic addiction) and maintenance of abstinence. To determine the optimal detoxification protocol, researchers enrolled 70 employed patients (mean age, 28; 94% white) who were primarily dependent on prescription opioids (mostly oxycodone) for 5 years, lacked major psychiatric comorbidity, and wanted detoxification. Participants were stabilized on manufacturer-supplied buprenorphine/naloxone and then randomized to behavior therapy plus a double-blind 1-, 2-, or 4-week taper of buprenorphine followed by maintenance therapy with naltrexone. Mean length of stabilization was 2 weeks.
The 4-week taper was superior to the shorter tapers, with 50% of patients in that group remaining in treatment, abstinent, and receiving naltrexone after 12 weeks, versus 21% for the other groups. Patients who required 8 mg or more of buprenorphine for stabilization were only one fourth as likely as those needing lower dosages to have a favorable outcome.
Sigmon SC et al. A randomized, double-blind evaluation of buprenorphine taper duration in primary prescription opioid abusers. JAMA Psychiatry 2013 Oct 23; [e-pub ahead of print]. (http://dx.doi.org/10.1001/jamapsychiatry.2013.2216)
Comment
Because of federal regulations, buprenorphine and buprenorphine/naloxone are more readily available than methadone for the treatment of narcotic dependence, and they are more frequently used for patients with the less complicated addictions to prescription opioids. Still, only 50% of patients who were motivated to stop taking the narcotic and to be maintained with a narcotic antagonist did well for just 3 months after the longest taper. In view of this and of other data reporting much lower rates of abstinence and treatment retention after buprenorphine withdrawal, there may exist a larger group of patients, especially those with comorbid psychiatric disorders, who require longer stabilization, extended tapers, and prolonged maintenance.