Outpatients addicted to prescription opioids may benefit from a 4-week taper regimen followed by naltrexone maintenance, according to data published in JAMA Psychiatry.
Compared with prescription opioid-dependent adults who were tapered off for 1 or 2 weeks, those who were tapered off for 4 weeks experienced better treatment outcomes, including greater abstinence from opioids and treatment retention.
The double blind, 12-week randomized trial included 70 adult outpatients addicted to prescription opioids. Participants were randomly assigned to a buprenorphine tapering regimen of 1, 2 or 4 weeks, followed by naltrexone therapy. The intervention was split into two phases: phase 1 occurred between 1 and 5 weeks from randomization, during which time participants attended the outpatient clinic daily; phase 2 occurred between weeks 6 and 12, and participants attended the clinic three times per week. Behavioral therapy and urine toxicology tests were provided during both phases of the trial.
At the end of phase 1, 63% of participants in the 4-week taper group were abstinent from opioids vs. 29% in the 2-week and 1-week taper groups (P=.02). The same was true at the end of phase 2: 50% of those in the 4-week group vs. 16% of those in the 2-week group and 20% in the 1-week group abstained from opioids (P=.03). The 4-week taper group also consisted of more treatment responders (50%) than the 2-week (17%) and 1-week (21%) groups (P=.03) at the end of treatment.
Compared with 2-week and 1-week taper groups, participants in the 4-week group had superior retention and naltrexone ingestion (P=.04).
"Our results suggest that a subset of [prescription opioid] abusers may respond favorably to a brief but carefully crafted outpatient treatment involving buprenorphine detoxification, naltrexone maintenance and behavioral therapy," researchers wrote. "Additional controlled studies are needed to better understand the parameters of efficacious treatments for [prescription opioid] dependence, as well as to identify the individuals for whom brief vs. longer-term treatments are warranted."
Disclosure: Sigmon reports receiving past consulting payments from Alkermes and research support from Titan Pharmaceuticals. One other researcher reports being a paid mentor in the Physician Clinical Support System for training physicians in buprenorphine use.