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New study finds clonidine and buprenorphine useful in opioid withdrawal

Opiate dependence is a major public health concern associated with deadly diseases, homelessness, crime and death. “It is estimated that between 26.4 million and 36 million people abuse opioids worldwide, with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin.” (Volkow 2014)

The most popular form of opioid treatment uses methadone or suboxone for full opioid agonists, or buprenorphine for partial opioid agonists. Full agonists are opioid drugs that bind to mu-opioid receptors in the brain and cause them to produce endorphins, which result in pain relief and, depending on dosage, feelings of euphoria. Heroin, oxycodone, methadone, hydrocodone and morphine are all full agonists. Partial agonists are drugs that bind to mu-opioid receptors, causing them to produce endorphins, but to a much lesser extent than full agonists. Agonists are drugs that bind to the mu-opioid receptors, but do not stimulate the production of endorphins or euphoria.

Methadone is an example of a full opioid agonist and during its lifetime in the body, its effect is fairly similar to that of buprenorphine. Methadone will continue to send signals to the addict’s “mu-receptors” until all receptors are fully activated or until the maximum effect is reached. This results in higher dosages of opioids, which will result in stronger and harsher withdrawals.

Clonidine and opioid addiction

A recent study found that clonidine, a blood pressure and ADHD medication, taken with buprenorphine blocks stressed-induced relapse of opioids. A clinical trial conducted in December 2014 focused on 208 opioid-dependent patients at an outpatient buprenorphine clinic, which helped them maintain opioid abstinence for five to six weeks. Study participants were put on buprenorphine and randomly assigned to receive clonidine or a placebo, for 14 weeks. In an “intent to treat analysis”, clonidine produced the longest duration (in consecutive days) of abstinence from opioids. (American Journal of Psychiatry 2014)

The experiment concluded that clonidine is a useful medication for reducing withdrawal symptoms, assisting with treating stress and cravings post withdrawal, as well as increasing the duration of abstinence from full agonist opioids. “Ecological momentary assessment showed that daily-life stress was partly decoupled from opioid craving in the clonidine group, supporting the authors’ hypothesized mechanism for clonidine’s benefits,” according to the American Journal of Psychiatry.

Buprenorphine is a partial agonist, which is a semisynthetic opioid used to treat opioid addiction. Buprenorphine is able to activate opioid receptors in the brain, but at a lesser degree than a full agonist such as methadone; its effects will continue until it reaches its plateau. Once this “ceiling effect” is reached, the effects of the drug will not increase; as a result, this drug is less harmful if overdosed. Opioid users addicted to low doses of opiates might be able to discontinue their opioid use with limited withdrawal symptoms using buprenorphine; however, people addicted to higher dosages of opioids have higher success rates if treated with a full agonist such as methadone.

Other opioid addiction treatment options

Aside from treating opioid addiction with full or partial agonists, psychotherapy, exercise, medication, mindfulness therapies and 12-step programs are also extremely helpful in treating addictions to opioids. Cognitive behavioral therapy (CBT) and contingency management intervention (CMI) techniques have shown to be highly effective in treating opioid abuse, or addiction.

When an opioid addict is able to work with a therapist that he or she trusts, and build a relationship by openly discussing and planning a treatment strategy, recovery becomes easier. When working with a therapist in cognitive behavioral therapy, the opioid addict is able to pinpoint the negative thoughts, negative world-views, fears or disillusions that might be triggering his or her use of the drug. When the patient is able to identify what the negative thoughts are, then he or she can start to work on understanding how they take place and when. Once this is determined, the therapist works with the patient to understand which of these fears or negative thoughts are possibly false and/or inaccurate. Gradually, the two are able to work together to determine how the patient reacts to the thoughts or fears, and how the patient would like to react or act differently.

Contingency management intervention (CMI) works by rewarding the patient with monetary prizes of which he/she is able to earn based on behavior or ability to meet goals set with the therapist.

Both medication and therapy can be useful in treating opioid addiction. If you would like more information on how to find treatment for alcohol abuse or drug addiction, you can call the Recovery Hotline at 855-441-4405 to speak to a member of our team and start the journey to recovery today.

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