The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Substance Use and Related Disorders. Part 2: Opioid dependence

Abstract

There is enough high quality data to formulate evidence-based guidelines for the treatment of opioid abuse and dependence. This task force report provides evidence for the efficacy of a number of medications to treat opioid abuse and dependence, particularly the opioid agonists methadone or buprenorphine. These medications have great relevance for clinical practice.

Use of clonidine-naltrexone for rapid withdrawal in two patients dependent on intravenous morphine

“…In rapid detoxification using combination of naltrexone and clonidine, the use of naltrexone precipitates withdrawal symptoms but these are reduced by pretreatment with clonidine (6). The naltrexone can then be continued in the maintenance phase.…”

“…There is no significant difference in efficacy between lofexidine and clonidine (6). The lower incidence of hypotension makes lofexidine more suited for treatment in an outpatient setting than clonidine (6) Naltrexone is a competitive antagonist at the mu and kappa opiate receptors in the brain. It blocks the effect of opioids and reduces conditioned craving (4).…”

“…Concomitant use of heroin and methadone can lead to overdose. Buprenorphine is a partial µ opiate agonist which is given sublingually and is effective in the treatment of opioid withdrawal (6). Buprenorphine is used either alone or in combination with the opioid antagonist naloxone.…”

Commentary on Rosenthalet al. (2013): Buprenorphine implant-new hopes, old questions

“…Opioid substitution therapy (OST) with buprenorphine is one of the few long-term pharmacological interventions boasting of an established track record of efficacy for opioid dependence [1,2]. However, serious concerns about diversion, abuse and accidental misuse of buprenorphine have driven the industry towards renovating newer, relatively abuse-deterrent products such as a buprenorphinenaloxone combination (BNX) as sublingual tablets or films.…”

Buprenorphine Use and Risk of Abuse and Diversion

“…Clinical studies of the detoxification effects of methadone, primarily in moderate dosages (50-60 mg), and buprenorphine (12-16 mg) have generally demonstrated comparable efficacy for the two drugs [37][38][39]. For more details on the use of buprenorphine in opioid dependence, see Soyka et al [25].…”