Buprenorphine for managing opioid withdrawal

Gowing, Linda; Ali, Robert; White, Jason M.; Mbewe, Dalitso

doi:10.1002/14651858.cd002025.pub5

Cited by 83 publications

(74 citation statements)

References 124 publications

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“…[69][70][71] If withdrawal management is offered as part of an immediate transition to psychosocial or residential treatment, then, among available pharmacologic approaches used for withdrawal management, a buprenorphine-naloxone taper may offer advantages such as faster symptom relief and higher rates of withdrawal completion over methadone tapers. 71 If cessation of opioid use is achieved, oral naltrexone can be considered as an adjunct medication to support abstinence (low-quality evidence).…”

Section: Offering Withdrawal Management Alone (Ie Detoxification Wmentioning

confidence: 99%

Management of opioid use disorders: a national clinical practice guideline

Bruneau

Ahamad

Goyer

et al. 2018

CMAJ

338

392

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Section: Offering Withdrawal Management Alone (Ie Detoxification Wmentioning

confidence: 99%

Management of opioid use disorders: a national clinical practice guideline

Bruneau

Ahamad

Goyer

et al. 2018

CMAJ

338

392

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“…4 In adults, sublingual buprenorphine is used to reduce symptoms of opioid withdrawal. 6 Buprenorphine has a wide therapeutic index for respiratory depression and a long half-life that may make it useful for treatment of the neonatal abstinence syndrome. Open-label investigations have established a pharmacokinetic profile in neonates 7 and suggested favorable safety and efficacy for this indication.…”

mentioning

confidence: 99%

Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome

et al. 2017

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BACKGROUND Current pharmacologic treatment of the neonatal abstinence syndrome with morphine is associated with a lengthy duration of therapy and hospitalization. Buprenorphine may be more effective than morphine for this indication. METHODS In this single-site, double-blind, double-dummy clinical trial, we randomly assigned 63 term infants (≥37 weeks of gestation) who had been exposed to opioids in utero and who had signs of the neonatal abstinence syndrome to receive either sublingual buprenorphine or oral morphine. Infants with symptoms that were not controlled with the maximum dose of opioid were treated with adjunctive phenobarbital. The primary end point was the duration of treatment for symptoms of neonatal opioid withdrawal. Secondary clinical end points were the length of hospital stay, the percentage of infants who required supplemental treatment with phenobarbital, and safety. RESULTS The median duration of treatment was significantly shorter with buprenorphine than with morphine (15 days vs. 28 days), as was the median length of hospital stay (21 days vs. 33 days) (P<0.001 for both comparisons). Adjunctive phenobarbital was administered in 5 of 33 infants (15%) in the buprenorphine group and in 7 of 30 infants (23%) in the morphine group (P = 0.36). Rates of adverse events were similar in the two groups. CONCLUSIONS Among infants with the neonatal abstinence syndrome, treatment with sublingual buprenorphine resulted in a shorter duration of treatment and shorter length of hospital stay than treatment with oral morphine, with similar rates of adverse events.

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“…Since the 1990s, there have been dozens of RCTs and several systematic reviews that examine the effectiveness of buprenorphine versus other pharmacological treatments, including methadone. The most recent Cochrane systematic review examined 27 RCTs and concluded that buprenorphine is about as effective as methadone in ameliorating withdrawal and suggested no difference in average treatment duration (Gowing et al, 2017). Compared with other pharmacological treatments, such as clonidine and lofexidine, buprenorphine was found to be superior in treatment retention and reducing withdrawal severity.…”

Section: Box 11 Fda-approved Medications Currently Offered For Treamentioning

confidence: 99%

Considering Heroin-Assisted Treatment and Supervised Drug Consumption Sites in the United States

Kilmer¹,

Taylor²,

Caulkins³

et al. 2018

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show abstract

Buprenorphine for managing opioid withdrawal

Cited by 83 publications

References 124 publications

Management of opioid use disorders: a national clinical practice guideline

Management of opioid use disorders: a national clinical practice guideline

Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome

Considering Heroin-Assisted Treatment and Supervised Drug Consumption Sites in the United States

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