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Tuesday, October 21, 2014

Buprenorphine Maintenance Over Detox

Buprenorphine has become the standard in treating opioid addiction. Whether it is used for detoxification or for maintenance, many in the field of addiction believe that formulations of buprenorphine, drugs like Subutex and Suboxone, are more effective than methadone.

There are two schools of thought regarding buprenorphine treatment with regards to detoxification and maintenance. Some addiction professionals hold that the sooner a patient gets off all opioid related substances, the better. While some believe that there is a greater chance of long term abstinence if the transition is more gradual.

New research from Yale University indicates that buprenorphine maintenance therapy is more effective than detoxification when treating prescription opioid dependence, Health Canal reports. The researchers followed 113 patients with prescription opioid dependence over the course of 14-weeks.

The participants were separated into two groups, a maintenance group and a detox group. In both groups, patients received drug counseling and were attended to by doctors and nurses. The maintenance group received ongoing buprenorphine therapy over the 14-week period. The detox group received six weeks of stable doses of buprenorphine followed by three weeks of tapering doses.

Over the 14-week period the detox group tested positive for illicit opioid use more often than those in the maintenance group, lead researcher Dr. David Fiellin reported in JAMA Internal Medicine. The research showed that detox group patients were less likely to stay in treatment or abstain from using opioids after they stopped taking buprenorphine.

“For prescription opioid dependence, buprenorphine detoxification is less effective than ongoing maintenance treatment, and increases the risk of overdose and other adverse events,” Fiellin said in a news release. “It is very common for patients seeking treatment to request detoxification.”

“They want to be off of everything as soon as possible as opposed to considering long-term treatment, but unfortunately there’s no quick fix for the disease. The majority of patients will do better if they receive ongoing maintenance treatment.”

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