Provision of ancillary medications during buprenorphine detoxification does not improve treatment outcomes.

For individuals dependent on opioids, recovery efforts begin with a period of withdrawal that typically includes discomfort from symptoms, possibly precipitating a return to drug use. The study described here, a secondary analysis of individuals enrolled in the National Drug Abuse Treatment Clinical Trials Network study CTN-0002 (“Buprenorphine/Naloxone versus Clonidine for Outpatient Opiate Detoxification”), investigated whether the provision of ancillary medications for opioid withdrawal symptoms affected treatment outcomes in 139 participants receiving buprenorphine in a 13-day detoxification trial. Outcomes measures include the number of opioid-free urine samples collected and retention in treatment. Ancillary medications were provided to 70% of participants: 59% received medication for insomnia, 45% for anxiety, 40% for bone pain, 35% for nausea, and 28% for diarrhea.

Findings indicate no difference in the number of opioid-free urine samples between the group receiving ancillary medication and the group who did not, although tests of specific ancillary medications indicate that those who received diarrhea medication had fewer opioid-free urines than those who did not (P = .004). Results also indicate that participants attended fewer days of treatment if they received anxiety, nausea, or diarrhea medication compared to no medication (all P values < .05). Clinicians treating individuals dependent on opioids should consider high rates of craving and withdrawal symptoms and the need for ancillary medications as a red flag for further monitoring and assessment. Practice changes that may be required include adjusting buprenorphine dose, increasing provision of ancillary medications, switching to another pharmacotherapy, or providing alternatives to medication for treating withdrawal symptoms, and monitoring patients to ensure they are taking buprenorphine as instructed.

Related protocols: CTN-0002