3 METHODS OF OPIOID DETOXIFICATION IN A PRIMARY-CARE SETTING - A RANDOMIZED TRIAL

Background: Opioid detoxification in a primary care setting followed b y ongoing substance abuse treatment may be appropriate for selected op ioid-dependent patients. Objective: To compare three pharmacologic pro tocols for opioid detoxification in a primary care setting. Design: Ra ndomized, double-blind clinical trial with random assignment to treatm ent protocols. Setting: A free-standing primary care clinic affiliated with drug treatment programs. Patients: 162 heroin-dependent patients . Interventions: Three detoxification protocols: clonidine, combined c lonidine and naltrexone, and buprenorphine. Measurements: Successful d etoxification (that is, when study participants received a full opioid -blocking dose [50 mg] of naltrexone), treatment retention (8 days), a nd withdrawal symptoms. Results: Overall, 65% of participants (36 of 5 5) who received clonidine, 81% (44 of 54) who received combined clonid ine and naltrexone, and 81% (43 of 53) who received buprenorphine were successfully detoxified. Retention did not differ significantly acros s the groups: 65% of participants (36 of 55) who received clonidine, 5 4% (29 of 54) who received combined clonidine and naltrexone, and 60% (32 of 53) who received buprenorphine. Participants who received bupre norphine had a significantly lower mean withdrawal symptom score than those who received clonidine or combined clonidine and naltrexone. Con clusions: Participants in the combined clonidine and naltrexone group and those in the buprenorphine group were more likely to complete deto xification, although retention at 8 days did not differ among the grou ps. Participants who were assigned to the buprenorphine group experien ced less severe withdrawal symptoms than those assigned to the other t wo groups.