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Heroin Addiction and Related Clinical Problems: 2021, 23, N6 (pages: 51 - 57)

Buprenorphine for opioid withdrawal syndrome management: comparison of different dose tapering protocols

Stella L., D'Ambra C., Di Donato L., Infantino R., Boccella S., Mirto B.F., Luongo L., Miele M., Pieretti G., Maione S., and Guida F.

Summary: Background. Buprenorphine (Bup) is a partial μ-opioid antagonist that has been approved both for the treatment of moderate-severe pain and Opioid Use Disorder (OUD). Based on its high affinity for the μ-opioid receptor, Bup inhibits the effects of exogenously administered opioids, while limiting the potential for overdoses or respiratory suppression. The potential of Bup has been known for years, even if the results of its use in opioid detoxification are still controversial. One of the major practical concerns is the lack of shared procedures in treatment duration and dose tapering. Methods. In the present study we have examined the feasibility of a brief detoxification in OUD patients treated with a Bup-based protocol that is followed, when appropriate, by naltrexone (NTX). The study investigated the effectiveness of different dose-tapering detoxification protocols, in terms of withdrawal syndrome symptoms, and the probability of staying in therapy to allow the completion of detoxification treatment. Results. We found significant differences in withdrawal symptoms between the group of patients who experienced progressive dosage reduction, with respect to a variety of treatment protocols. Withdrawal syndrome severity was assessed in each group by two indices (Stella Scale and Wesson & Ling Scale), but no significant differences were found between the two respective ratings obtained in each study group. Moreover, the same group was distinguished by an only slightly positive result for when taking urinary toxicological tests (on the possible presence of morphine metabolites), compared with other groups, so indicating a better retention of opiate-free status. Conclusions. Our data suggest the gradual reduction of the Bup dose as typically accompanying the successful outcome of steady outpatient Bup detoxification treatment, in contrast with an abrupt form.