PRIMARY CARE-BASED AMBULATORY OPIOID DETOXIFICATION - THE RESULTS OF A CLINICAL-TRIAL

OBJECTIVE: To determine the feasibility of primary care-based ambulato ry opioid detoxification (AOD) using two protocols: clonidine and clon idine plus naltrexone. SETTING: The Central Medical Unit (CMU)-a frees tanding primary care medical clinic staffed by physicians and nurse pr actitioners. PATIENTS: Injection drug users (IDUs) seeking substance a buse treatment between the ages of 18 and 50 years who were addicted t o opioids (e.g., heroin) and not currently in drug treatment. INTERVEN TIONS: In the clonidine protocol, clonidine was administered every 4 h ours ''as needed'' for up to 12 days. In the clonidine plus naltrexone protocol, clonidine was administered and naltrexone was administered in increasing doses over five days. Both protocols included ''adjuvant '' medications for muscle cramps, insomnia, and vomiting. Successfully detoxified patients were referred to ongoing drug treatment. DESIGN: A prospective nonrandomized clinical trial. MEASUREMENTS AND MAIN RESU LTS: One hundred forty opioid-addicted IDUs were referred to the medic al clinic for AOD, Among the 125 patients who enrolled in the study, 5 7 selected clonidine and 68 selected clonidine/naltrexone. The treatme nt groups (clonidine vs clonidine/naltrexone) were similar at baseline with respect to: age at first heroin use (21 years vs 23 years), mean admission opioid craving score (45/100 vs 49/100), and withdrawal sym ptom score (19/72 vs 18/72), Overall, 70% (88/125) of the AODs were su ccessful, including 42% (24/57) for clonidine and 94% (64/68) for clon idine/naltrexone (p < 0.001). CONCLUSIONS: This study suggests that pr imary care-based AOD can be safely and effectively carried out by prim ary care providers and that clonidine/naltrexone may be more effective in this setting than is clonidine alone, Ambulatory opioid detoxifica tion can give internists a larger role in initiating drug treatment fo r IDUs who are addicted to opioids.