• Walter Ling, Leslie Amass, Steve Shoptaw, Jeffrey J Annon, Maureen Hillhouse, Dean Babcock, Greg Brigham, Judy Harrer, Malcolm Reid, Joan Muir, Betty Buchan, Debbie Orr, George Woody, Jonathan Krejci, Douglas Ziedonis, and Buprenorphine Study Protocol Group.
• David Geffen School of Medicine, NPI/Integrated Substance Abuse Programs, University of California, Los Angeles, CA 90025, USA. lwalter@ix.netcom.com
• Addiction. 2005 Aug 1;100(8):1090-100.

AimsThe clinical effectiveness of buprenorphine-naloxone (bup-nx) and clonidine for opioid detoxification in in-patient and out-patient community treatment programs was investigated in the first studies of the National Institute of Drug Abuse Clinical Trials Network.DesignDiagnostic and Statistical Manual version IV (DSM IV)-diagnosed opioid-dependent individuals seeking short-term treatment were randomly assigned, in a 2 : 1 ratio favoring bup-nx, to a 13-day detoxification using bup-nx or clonidine.MethodsA total of 113 in-patients (77 bup-nx, 36 clonidine) and 231 out-patients (157 bup-nx, 74 clonidine) participated. Supportive interventions included appropriate ancillary medications and standard counseling procedures guided by a self-help handbook. The criterion for treatment success was defined as the proportion of participants in each condition who were both retained in the study for the entire duration and provided an opioid-free urine sample on the last day of clinic attendance. Secondary outcome measures included use of ancillary medications, number of side effects reported and withdrawal and craving ratings.FindingsA total of 59 of the 77 (77%) in-patients assigned to the bup-nx condition achieved the treatment success criterion compared to eight of the 36 (22%) assigned to clonidine, whereas 46 of the 157 (29%) out-patients assigned to the bup-nx condition achieved the treatment success criterion, compared to four of the 74 (5%) assigned to clonidine.ConclusionThe benefits of bup-nx for opioid detoxification are supported and illustrate important ways in which clinical research can be conducted in community treatment programs.

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