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Outpatient detoxification may help opioid painkiller addiction

An estimated 26.4 million to 36 million people abuse opioids worldwide, with around 2.1 million people in the United States addicted to prescription opioid pain relievers in 2012.

The consequences of this abuse have been devastating and are on the rise as the number of unintentional overdose deaths from prescription pain relievers has soared in the United States, more than quadrupling since 1999. There is also expanding evidence to suggest a relationship between increased non-medical use of opioid analgesics and heroin abuse in the United States.

A recent NIDA-funded clinical trial depicted a significant portion of individuals addicted to opioid painkillers that may begin and maintain abstinence through a brief, but intensive outpatient detoxification treatment followed by naltrexone therapy, an opioid antagonist.

Dr. Stacey Sigmon and colleagues at the University of Vermont in Burlington observed 70 adults addicted to opioid painkillers in a double-blind, randomized clinical trial that involved a three-step detoxification process. First was the stabilization through Suboxone that suppresses withdrawal symptoms, cravings and illicit use of opioid painkillers. This was followed by a gradual alteration of the Suboxone dose over one, two or four weeks. Lastly, transition to the opioid antagonist naltrexone was made once an opioid-negative urine sample was extracted and no opioid use was reported within the past 24 hours.

The trial participants further received twice-a-week behavioral therapy using the evidence-based Community Reinforcement Approach and underwent staff-observed urinalysis testing thrice a week. Supplementary non-opioid medications were used as needed to treat breakthrough withdrawal symptoms.

The patients randomly assigned to the four-week suboxone pattern presented the highest percentage of opioid–free urine samples during the 12-week trial. Out of this population of 22 patients, 63 percent were abstinent at the five-week mark, and 50 percent continued to be opioid-abstinent at the end of the 12-week trial. Contrarily, 29 percent of each of the two groups with shorter tapers provided drug-free urine samples at five weeks, and 20 percent or less of each provided drug-free samples at 12 weeks.

Dr. Sigmon noted that outpatient detoxification may be particularly appropriate for patients who are present for treatment with less severe opioid dependence. “This finding may hold particular relevance for prescription opioid abusers, many of whom are younger and have briefer histories of opioid dependence, less severe other drug use, less IV use, and greater psychosocial stability than past generations of primary heroin abusers.

“Detoxification is typically associated with high relapse rates and return to opioid abuse,” Dr. Sigmon continued. “However, some data also suggests (sic) that if you do it right, outpatient detoxification can be effective. The inclusion of naltrexone therapy is likely to be extremely important to help prevent resumption of illicit opioid use following detoxification.”

Dr. Will Aklin, acting chief in NIDA’s Behavioral and Integrative Treatment Branch, believes the current rates of opioid painkiller misuse and dependence to have put a significant strain on treatment resources and created challenges for researchers and clinicians who strive for effective therapies.

“The Vermont team’s findings represent a meaningful advance toward meeting that challenge,” Dr. Aklin claimed.

The misfortune of becoming addicted to a substance of abuse is not an easy battle. However, there is a way to reclaim your life and live it freely. This path to recovery begins with a phone call. The 24/7 Recovery Helpline is here to help you find the best treatment plans and top-quality aftercare programs. If you or a loved one is currently seeking recovery, call us right away at 855-441-4405.

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