Thursday, November 14, 2013

Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers Confirms What We Know About Relapse After Tx Ends

A recent publication reported on "A Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers." (Sigmon et al, JAMAPsych, published on-line 23 Oct 2013).  The authors conclude that their findings "...suggest that a meaningful subset of PO [Prescription Opioid] - dependent outpatients may respond positively to a 4-week taper plus naloxone maintenance intervention." lt would seem this is an overly positive assessment.
First, the number of subjects is very small; the best outcomes were achieved with just 22 individuals assigned to the 4-week taper group. Furthermore, "the best" was not particularly good, since half of these individuals had relapsed to non-prescribed opioid use 4 weeks after detoxification was completed and before "naloxone maintenance" could even be initiated.
The trial seems merely to confirm what has been known for decades: when treatment of opioid dependence ends, relapse is the rule rather than the exception, and this reality applies regardless of the duration of detoxification or associated medical or psychosocial support hat is offered. lt is this stark reality that must be conveyed to those seeking care, along with the fact that, as the authors acknowledge, "agonist maintenance is the recommended treatment for most opioid-dependent patients". The challenge is not to determine which detoxification schedule is a bit better than another, but to ensure access to long-term treatment that so many dependent individuals want and need - and without which many will die.