Buprenorphine/naloxone,
methadone and
lofexidine are medications with utility in the treatment of
opiate withdrawal. We report the first randomised controlled trial to compare the effects of these two medications on
withdrawal symptoms and outcome during
opiate induction/stabilisation and detoxification. A double-blind randomised controlled trial was conducted in an outpatient satellite clinic of a specialist
drug service. Eighty
opiate dependent individuals meeting DSM-IV criteria for
opiate dependence, using ⩽ ½ g
heroin smoked/chased or ¼ g
heroin injected or ⩽ 30mg
methadone, with ⩽ 3 years of
opioid dependency, underwent a short-term
opiate treatment programme involving induction/stabilisation on
methadone 30mg or
buprenorphine/naloxone 4mg/1mg, followed by detoxification (where the
methadone group was assisted by
lofexidine). The main outcome measures were urine
drug screens for
opiates and withdrawal and craving questionnaires. There were no overall differences in positive urine
drug screens and drop-outs during any phase of the study. During induction/stabilisation,
withdrawal symptoms subsided more slowly for
buprenorphine/naloxone than for
methadone, and craving was significantly higher in the
buprenorphine/naloxone group ( p<0.05, 95% confidence interval -3.5, -0.38). During detoxification,
withdrawal symptoms were significantly greater and the peak of withdrawal was earlier for the
methadone/
lofexidine group than the
buprenorphine/naloxone group ( p<0.01, 95% confidence interval 3.0, 8.3).
Methadone/
lofexidine and
buprenorphine/naloxone had comparable outcomes during rapid outpatient stabilisation and detoxification in low dose
opiate users.