Lofexidine versus diazepam for the treatment of opioid withdrawal syndrome: A double-blind randomized clinical trial in Singapore
Many individuals leave costly inpatient detoxification programs prematurely because of the severity of withdrawal symptoms experienced. In the absence of opioid-assisted detoxification in Singapore, diazepam is used to manage withdrawal. However since diazepam is addictive, there is a need to explor...
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| Veröffentlicht in: | Journal of substance abuse treatment 2018-08, Vol.91, p.1-11 |
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| creator | Guo, Song Manning, Victoria Yang, Yi Koh, Puay Kee Chan, Edwin de Souza, Nurun Nisa Assam, Pryseley Nkouibert Sultana, Rehena Wijesinghe, Ruki Pangjaya, Julius Kandasami, Gomathinayagam Cheok, Christopher Lee, Kae Meng Wong, Kim Eng |
| description | Many individuals leave costly inpatient detoxification programs prematurely because of the severity of withdrawal symptoms experienced. In the absence of opioid-assisted detoxification in Singapore, diazepam is used to manage withdrawal. However since diazepam is addictive, there is a need to explore the effectiveness of alternative medications.
The study aimed to examine the safety and efficacy of lofexidine, a non-opiate, non-addictive, alpha 2-adrenergic agonist in assisting opioid detoxification in Singapore, using a randomized, double-blind, investigator-initiated placebo-controlled trial comparing lofexidine against diazepam. Opioid dependent patients (n = 111) were randomized to receive a 10-day course of lofexidine (n = 56) or diazepam (n = 55). The primary endpoint was the Objective Opioid Withdrawal Scale (OOWS) score on days 3 and 4 and secondary outcomes were the Short Opioid Withdrawal Scale (SOWS) score, program retention rate, and ratings of opiate craving.
The OOWS, SOWS and opiate craving scores were consistently lower in the lofexidine group relative to the diazepam group over the 14-day study period; however no statistically significant differences were found on days 3 and 4 (peak withdrawal). Changes in mean pupil size during peak withdrawal were significantly smaller in the lofexidine group and more participants in the lofexidine group remained in treatment and completed detoxification.
Lofexidine was at least as effective as diazepam in reducing the opioid withdrawal syndrome and increased treatment retention. In addition to its non-addictive and non-abuse properties, lofexidine has several clinical advantages over diazepam. The use of lofexidine is recommended when opioid-assisted medications are not available.
•Lofexidine is as effective as diazepam at reducing the opioid withdrawal syndrome.•Lofexidine increases the treatment duration and completion of opioid detoxification.•Lofexidine is safe and well-tolerated during opioid withdrawal. |
| doi_str_mv | 10.1016/j.jsat.2018.04.012 |
| format | Article |
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The study aimed to examine the safety and efficacy of lofexidine, a non-opiate, non-addictive, alpha 2-adrenergic agonist in assisting opioid detoxification in Singapore, using a randomized, double-blind, investigator-initiated placebo-controlled trial comparing lofexidine against diazepam. Opioid dependent patients (n = 111) were randomized to receive a 10-day course of lofexidine (n = 56) or diazepam (n = 55). The primary endpoint was the Objective Opioid Withdrawal Scale (OOWS) score on days 3 and 4 and secondary outcomes were the Short Opioid Withdrawal Scale (SOWS) score, program retention rate, and ratings of opiate craving.
The OOWS, SOWS and opiate craving scores were consistently lower in the lofexidine group relative to the diazepam group over the 14-day study period; however no statistically significant differences were found on days 3 and 4 (peak withdrawal). Changes in mean pupil size during peak withdrawal were significantly smaller in the lofexidine group and more participants in the lofexidine group remained in treatment and completed detoxification.
Lofexidine was at least as effective as diazepam in reducing the opioid withdrawal syndrome and increased treatment retention. In addition to its non-addictive and non-abuse properties, lofexidine has several clinical advantages over diazepam. The use of lofexidine is recommended when opioid-assisted medications are not available.
•Lofexidine is as effective as diazepam at reducing the opioid withdrawal syndrome.•Lofexidine increases the treatment duration and completion of opioid detoxification.•Lofexidine is safe and well-tolerated during opioid withdrawal.</description><identifier>ISSN: 0740-5472</identifier><identifier>EISSN: 1873-6483</identifier><identifier>DOI: 10.1016/j.jsat.2018.04.012</identifier><identifier>PMID: 29910009</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Clinical outcomes ; Clinical research ; Clinical trials ; Craving ; Detoxification ; Diazepam ; Double-blind studies ; Drug abuse ; Drug therapy ; Drug withdrawal ; Efficacy ; Hospitalization ; Inpatients ; Lofexidine ; Narcotics ; Opioid-withdrawal syndrome ; Opioids ; Placebo-controlled ; RCT ; Severity ; Substance abuse treatment ; Valium ; Withdrawal symptoms</subject><ispartof>Journal of substance abuse treatment, 2018-08, Vol.91, p.1-11</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><rights>Copyright Pergamon Press Inc. Aug 2018</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-b94a90b0a13487c69f8a2a39d4f0b2a28f30b0a32c6522a02c6abd0b9681fcc3</citedby><cites>FETCH-LOGICAL-c384t-b94a90b0a13487c69f8a2a39d4f0b2a28f30b0a32c6522a02c6abd0b9681fcc3</cites><orcidid>0000-0002-0155-8642</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jsat.2018.04.012$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,778,782,3539,27907,27908,30982,45978</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29910009$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Guo, Song</creatorcontrib><creatorcontrib>Manning, Victoria</creatorcontrib><creatorcontrib>Yang, Yi</creatorcontrib><creatorcontrib>Koh, Puay Kee</creatorcontrib><creatorcontrib>Chan, Edwin</creatorcontrib><creatorcontrib>de Souza, Nurun Nisa</creatorcontrib><creatorcontrib>Assam, Pryseley Nkouibert</creatorcontrib><creatorcontrib>Sultana, Rehena</creatorcontrib><creatorcontrib>Wijesinghe, Ruki</creatorcontrib><creatorcontrib>Pangjaya, Julius</creatorcontrib><creatorcontrib>Kandasami, Gomathinayagam</creatorcontrib><creatorcontrib>Cheok, Christopher</creatorcontrib><creatorcontrib>Lee, Kae Meng</creatorcontrib><creatorcontrib>Wong, Kim Eng</creatorcontrib><title>Lofexidine versus diazepam for the treatment of opioid withdrawal syndrome: A double-blind randomized clinical trial in Singapore</title><title>Journal of substance abuse treatment</title><addtitle>J Subst Abuse Treat</addtitle><description>Many individuals leave costly inpatient detoxification programs prematurely because of the severity of withdrawal symptoms experienced. In the absence of opioid-assisted detoxification in Singapore, diazepam is used to manage withdrawal. However since diazepam is addictive, there is a need to explore the effectiveness of alternative medications.
The study aimed to examine the safety and efficacy of lofexidine, a non-opiate, non-addictive, alpha 2-adrenergic agonist in assisting opioid detoxification in Singapore, using a randomized, double-blind, investigator-initiated placebo-controlled trial comparing lofexidine against diazepam. Opioid dependent patients (n = 111) were randomized to receive a 10-day course of lofexidine (n = 56) or diazepam (n = 55). The primary endpoint was the Objective Opioid Withdrawal Scale (OOWS) score on days 3 and 4 and secondary outcomes were the Short Opioid Withdrawal Scale (SOWS) score, program retention rate, and ratings of opiate craving.
The OOWS, SOWS and opiate craving scores were consistently lower in the lofexidine group relative to the diazepam group over the 14-day study period; however no statistically significant differences were found on days 3 and 4 (peak withdrawal). Changes in mean pupil size during peak withdrawal were significantly smaller in the lofexidine group and more participants in the lofexidine group remained in treatment and completed detoxification.
Lofexidine was at least as effective as diazepam in reducing the opioid withdrawal syndrome and increased treatment retention. In addition to its non-addictive and non-abuse properties, lofexidine has several clinical advantages over diazepam. The use of lofexidine is recommended when opioid-assisted medications are not available.
•Lofexidine is as effective as diazepam at reducing the opioid withdrawal syndrome.•Lofexidine increases the treatment duration and completion of opioid detoxification.•Lofexidine is safe and well-tolerated during opioid withdrawal.</description><subject>Clinical outcomes</subject><subject>Clinical research</subject><subject>Clinical trials</subject><subject>Craving</subject><subject>Detoxification</subject><subject>Diazepam</subject><subject>Double-blind studies</subject><subject>Drug abuse</subject><subject>Drug therapy</subject><subject>Drug withdrawal</subject><subject>Efficacy</subject><subject>Hospitalization</subject><subject>Inpatients</subject><subject>Lofexidine</subject><subject>Narcotics</subject><subject>Opioid-withdrawal syndrome</subject><subject>Opioids</subject><subject>Placebo-controlled</subject><subject>RCT</subject><subject>Severity</subject><subject>Substance abuse treatment</subject><subject>Valium</subject><subject>Withdrawal symptoms</subject><issn>0740-5472</issn><issn>1873-6483</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><recordid>eNp9kU1v1DAQhi0EokvhD3BAlrhwSRg72cRGXKqKL2klDvRuOfaEOkrsYDst7Y1_jldbOHDg4pE9z7yy5iHkJYOaAeveTvWUdK45MFFDWwPjj8iOib6pulY0j8kO-haqfdvzM_IspQkAOAfxlJxxKVm5yR35dQgj_nTWeaQ3GNOWqHX6Hle90DFEmq-R5og6L-gzDSMNqwvO0luXr23Ut3qm6c7bGBZ8Ry-oDdswYzXMzlsatbdhcfdoqSkPzhQ4R1dO5-k357_rNUR8Tp6Mek744qGek6uPH64uP1eHr5--XF4cKtOINleDbLWEATRrWtGbTo5Cc91I244wcM3F2By7DTfdnnMNperBwiA7wUZjmnPy5hS7xvBjw5TV4pLBedYew5YUh33X76VouoK-_gedwhZ9-VyhBOcCeA-F4ifKxJBSxFGt0S063ikG6uhHTeroRx39KGhV8VOGXj1Eb8OC9u_IHyEFeH8CsKzixmFUyTj0Bq2LaLKywf0v_zeP2aMB</recordid><startdate>201808</startdate><enddate>201808</enddate><creator>Guo, Song</creator><creator>Manning, Victoria</creator><creator>Yang, Yi</creator><creator>Koh, Puay Kee</creator><creator>Chan, Edwin</creator><creator>de Souza, Nurun Nisa</creator><creator>Assam, Pryseley Nkouibert</creator><creator>Sultana, Rehena</creator><creator>Wijesinghe, Ruki</creator><creator>Pangjaya, Julius</creator><creator>Kandasami, Gomathinayagam</creator><creator>Cheok, Christopher</creator><creator>Lee, Kae Meng</creator><creator>Wong, Kim Eng</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>K7.</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0155-8642</orcidid></search><sort><creationdate>201808</creationdate><title>Lofexidine versus diazepam for the treatment of opioid withdrawal syndrome: A double-blind randomized clinical trial in Singapore</title><author>Guo, Song ; Manning, Victoria ; Yang, Yi ; Koh, Puay Kee ; Chan, Edwin ; de Souza, Nurun Nisa ; Assam, Pryseley Nkouibert ; Sultana, Rehena ; Wijesinghe, Ruki ; Pangjaya, Julius ; Kandasami, Gomathinayagam ; Cheok, Christopher ; Lee, Kae Meng ; Wong, Kim Eng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-b94a90b0a13487c69f8a2a39d4f0b2a28f30b0a32c6522a02c6abd0b9681fcc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Clinical outcomes</topic><topic>Clinical research</topic><topic>Clinical trials</topic><topic>Craving</topic><topic>Detoxification</topic><topic>Diazepam</topic><topic>Double-blind studies</topic><topic>Drug abuse</topic><topic>Drug therapy</topic><topic>Drug withdrawal</topic><topic>Efficacy</topic><topic>Hospitalization</topic><topic>Inpatients</topic><topic>Lofexidine</topic><topic>Narcotics</topic><topic>Opioid-withdrawal syndrome</topic><topic>Opioids</topic><topic>Placebo-controlled</topic><topic>RCT</topic><topic>Severity</topic><topic>Substance abuse treatment</topic><topic>Valium</topic><topic>Withdrawal symptoms</topic><toplevel>online_resources</toplevel><creatorcontrib>Guo, Song</creatorcontrib><creatorcontrib>Manning, Victoria</creatorcontrib><creatorcontrib>Yang, Yi</creatorcontrib><creatorcontrib>Koh, Puay Kee</creatorcontrib><creatorcontrib>Chan, Edwin</creatorcontrib><creatorcontrib>de Souza, Nurun Nisa</creatorcontrib><creatorcontrib>Assam, Pryseley Nkouibert</creatorcontrib><creatorcontrib>Sultana, Rehena</creatorcontrib><creatorcontrib>Wijesinghe, Ruki</creatorcontrib><creatorcontrib>Pangjaya, Julius</creatorcontrib><creatorcontrib>Kandasami, Gomathinayagam</creatorcontrib><creatorcontrib>Cheok, Christopher</creatorcontrib><creatorcontrib>Lee, Kae Meng</creatorcontrib><creatorcontrib>Wong, Kim Eng</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>ProQuest Criminal Justice (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of substance abuse treatment</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Guo, Song</au><au>Manning, Victoria</au><au>Yang, Yi</au><au>Koh, Puay Kee</au><au>Chan, Edwin</au><au>de Souza, Nurun Nisa</au><au>Assam, Pryseley Nkouibert</au><au>Sultana, Rehena</au><au>Wijesinghe, Ruki</au><au>Pangjaya, Julius</au><au>Kandasami, Gomathinayagam</au><au>Cheok, Christopher</au><au>Lee, Kae Meng</au><au>Wong, Kim Eng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lofexidine versus diazepam for the treatment of opioid withdrawal syndrome: A double-blind randomized clinical trial in Singapore</atitle><jtitle>Journal of substance abuse treatment</jtitle><addtitle>J Subst Abuse Treat</addtitle><date>2018-08</date><risdate>2018</risdate><volume>91</volume><spage>1</spage><epage>11</epage><pages>1-11</pages><issn>0740-5472</issn><eissn>1873-6483</eissn><abstract>Many individuals leave costly inpatient detoxification programs prematurely because of the severity of withdrawal symptoms experienced. In the absence of opioid-assisted detoxification in Singapore, diazepam is used to manage withdrawal. However since diazepam is addictive, there is a need to explore the effectiveness of alternative medications.
The study aimed to examine the safety and efficacy of lofexidine, a non-opiate, non-addictive, alpha 2-adrenergic agonist in assisting opioid detoxification in Singapore, using a randomized, double-blind, investigator-initiated placebo-controlled trial comparing lofexidine against diazepam. Opioid dependent patients (n = 111) were randomized to receive a 10-day course of lofexidine (n = 56) or diazepam (n = 55). The primary endpoint was the Objective Opioid Withdrawal Scale (OOWS) score on days 3 and 4 and secondary outcomes were the Short Opioid Withdrawal Scale (SOWS) score, program retention rate, and ratings of opiate craving.
The OOWS, SOWS and opiate craving scores were consistently lower in the lofexidine group relative to the diazepam group over the 14-day study period; however no statistically significant differences were found on days 3 and 4 (peak withdrawal). Changes in mean pupil size during peak withdrawal were significantly smaller in the lofexidine group and more participants in the lofexidine group remained in treatment and completed detoxification.
Lofexidine was at least as effective as diazepam in reducing the opioid withdrawal syndrome and increased treatment retention. In addition to its non-addictive and non-abuse properties, lofexidine has several clinical advantages over diazepam. The use of lofexidine is recommended when opioid-assisted medications are not available.
•Lofexidine is as effective as diazepam at reducing the opioid withdrawal syndrome.•Lofexidine increases the treatment duration and completion of opioid detoxification.•Lofexidine is safe and well-tolerated during opioid withdrawal.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29910009</pmid><doi>10.1016/j.jsat.2018.04.012</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-0155-8642</orcidid></addata></record> |
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| source | Elsevier ScienceDirect Journals Complete - AutoHoldings; Applied Social Sciences Index & Abstracts (ASSIA) |
| subjects | Clinical outcomes Clinical research Clinical trials Craving Detoxification Diazepam Double-blind studies Drug abuse Drug therapy Drug withdrawal Efficacy Hospitalization Inpatients Lofexidine Narcotics Opioid-withdrawal syndrome Opioids Placebo-controlled RCT Severity Substance abuse treatment Valium Withdrawal symptoms |
| title | Lofexidine versus diazepam for the treatment of opioid withdrawal syndrome: A double-blind randomized clinical trial in Singapore |
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