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document
Primary care-based ambulatory opioid detoxification : the results of a clinical trial . OBJECTIVE To determine the feasibility of primary care-based ambulatory opioid detoxification ( AOD ) using two protocols : clonidine and clonidine plus naltrexone . SETTING The Central Medical Unit ( CMU ) -- a freestanding primary care medical clinic staffed by physicians and nurse practitioners . PATIENTS Injection drug users ( IDUs ) seeking substance abuse treatment between the ages of 18 and 50 years who were addicted to opioids ( e.g. , heroin ) and not currently in drug treatment . INTERVENTIONS In the clonidine protocol , clonidine was administered every 4 hours " as needed " for up to 12 days . In the clonidine plus naltrexone protocol , clonidine was administered and naltrexone was administered in increasing doses over five days . Both protocols included " adjuvant " medications for muscle cramps , insomnia , and vomiting . Successfully detoxified patients were referred to ongoing drug treatment . DESIGN A prospective nonrandomized clinical trial . MEASUREMENTS AND MAIN RESULTS One hundred forty opioid-addicted IDUs were referred to the medical clinic for AOD . Among the 125 patients who enrolled in the study , 57 selected clonidine and 68 selected clonidine/naltrexone . The treatment groups ( clonidine vs clonidine/naltrexone ) were similar at baseline with respect to : age at first heroin use ( 21 years vs 23 years ) , mean admission opioid craving score ( 45/100 vs 49/100 ) , and withdrawal symptom score ( 19/72 vs 18/72 ) . Overall , 70 % ( 88/125 ) of the AODs were successful , including 42 % ( 24/57 ) for clonidine and 94 % ( 64/68 ) for clonidine/naltrexone ( p < 0.001 ) . CONCLUSIONS This study suggests that primary care-based AOD can be safely and effectively carried out by primary care providers and that clonidine/naltrexone may be more effective in this setting than is clonidine alone . Ambulatory opioid detoxification can give internists a larger role in initiating drug treatment for IDUs who are addicted to opioids .
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Intervention_Pharmacological
clonidine
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Intervention_Pharmacological
clonidine plus naltrexone
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Intervention_Pharmacological
clonidine
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Intervention_Pharmacological
clonidine plus naltrexone
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Intervention_Pharmacological
naltrexone
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Outcome_Other
feasibility
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Outcome_Physical
primary care-based ambulatory opioid detoxification ( AOD )
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Outcome_Mental
mean admission opioid craving score
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Outcome_Mental
withdrawal symptom score
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Outcome_Physical
AODs
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Participant_Condition
substance abuse
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Participant_Age
18 and 50 years
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Participant_Sample-size
One hundred forty
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Participant_Sample-size
125
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Participant_Sample-size
57
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Participant_Sample-size
68
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Participant_Condition
addicted to opioids