• Lancet · Jun 2020

    Review

    New directions in the treatment of opioid withdrawal.

    • A Benjamin Srivastava, John J Mariani, and Frances R Levin.
    • Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA. Electronic address: benjamin.srivastava@nyspi.columbia.edu.
    • Lancet. 2020 Jun 20; 395 (10241): 1938-1948.

    AbstractThe treatment of opioid withdrawal is an important area of clinical concern when treating patients with chronic, non-cancer pain, patients with active opioid use disorder, and patients receiving medication for opioid use disorder. Current standards of care for medically supervised withdrawal include treatment with μ-opioid receptor agonists, (eg, methadone), partial agonists (eg, buprenorphine), and α2-adrenergic receptor agonists (eg, clonidine and lofexidine). Newer agents likewise exploit these pharmacological mechanisms, including tramadol (μ-opioid receptor agonism) and tizanidine (α2 agonism). Areas for future research include managing withdrawal in the context of stabilising patients with opioid use disorder to extended-release naltrexone, transitioning patients with opioid use disorder from methadone to buprenorphine, and tapering opioids in patients with chronic, non-cancer pain.Copyright © 2020 Elsevier Ltd. All rights reserved.

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