Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders
Background Medical treatment and detoxification from opiate disorders includes oral administration of opioid agonists. Dihydrocodeine (DHC) substitution treatment is typically low threshold and therefore has the capacity to reach wider groups of opiate users. Decisions to prescribe DHC to patients w...
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| Veröffentlicht in: | Cochrane database of systematic reviews 2020-02, Vol.2020 (2), p.CD012254, Article 012254 |
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| creator | Carney, Tara Van Hout, Marie Claire Norman, Ian Dada, Siphokazi Siegfried, Nandi Parry, Charles DH Carney, Tara |
| description | Background
Medical treatment and detoxification from opiate disorders includes oral administration of opioid agonists. Dihydrocodeine (DHC) substitution treatment is typically low threshold and therefore has the capacity to reach wider groups of opiate users. Decisions to prescribe DHC to patients with less severe opiate disorders centre on its perceived safety, reduced toxicity, shorter half‐life and more rapid onset of action, and potential retention of patients. This review set out to investigate the effects of DHC in comparison to other pharmaceutical opioids and placebos in the detoxification and substitution of individuals with opiate use disorders.
Objectives
To investigate the effectiveness of DHC in reducing illicit opiate use and other health‐related outcomes among adults compared to other drugs or placebos used for detoxification or substitution therapy.
Search methods
In February 2019 we searched Cochrane Drugs and Alcohol's Specialised Register, CENTRAL, PubMed, Embase and Web of Science. We also searched for ongoing and unpublished studies via ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and Trialsjournal.com. All searches included non‐English language literature. We handsearched references of topic‐related systematic reviews and the included studies.
Selection criteria
We included randomised controlled trials that evaluated the effect of DHC for detoxification and maintenance substitution therapy for adolescent (aged 15 years and older) and adult illicit opiate users.
The primary outcomes were abstinence from illicit opiate use following detoxification or maintenance therapy measured by self‐report or urinalysis. The secondary outcomes were treatment retention and other health and behaviour outcomes.
Data collection and analysis
We followed the standard methodological procedures that are outlined by Cochrane. This includes the GRADE approach to appraise the quality of evidence.
Main results
We included three trials (in five articles) with 385 opiate‐using participants that measured outcomes at different follow‐up periods in this review. Two studies with 150 individuals compared DHC with buprenorphine for detoxification, and one study with 235 participants compared DHC to methadone for maintenance substitution therapy. We downgraded the quality of evidence mainly due to risk of bias and imprecision.
For the two studies that compared DHC to buprenorphine, we found low‐quality e |
| doi_str_mv | 10.1002/14651858.CD012254.pub2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmed_primary_32068247</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2357471297</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4732-8170e1362a921220aaccfb146e6ceaa6bb8e89ce5ebf889fe7d5b2a28d0c460b3</originalsourceid><addsrcrecordid>eNqNkduKFDEQhhtR3HX1FZZcCtJjkj4kfSNor-4KC94oeBfSSbVT0p2MSXrXeXszOwfUG4VACuqrw19_UVwyumKU8tesbhsmG7nqryjjvKlXm2Xgj4rzXaLcZR4_xF1Zd9XXs-JZjN8prdqOi6fFWcVpK3ktzgt7heutDd54C-iAjD4QC8n_xBGNTugd0c6SWaNL4LQzQFIAnWZwiaDLz-Id2kVPkdxjWhO_QZ2ALBGIxeiDhRCfF0_GDMCLw39RfPnw_nN_U95-uv7Yv70tTS0qXkomKLCq5brjWRPV2phxyCKgNaB1OwwSZGeggWGUshtB2GbgmktLTd3Soboo3uz75lvMYE3eMehJbQLOOmyV16j-zDhcq2_-TgnKBecsN3h5aBD8jwViUjNGA9OkHfglKl41ohaMdyKj7R41wccYYDyNYVTtLFJHi9TRot1wngsvf1_yVHb0JANyD9zD4MdoEPLVTxiltGGCiVbmiFY9pgeXer-4lEtf_X9ppt8daJxgq4w365CF_kPAX3J-AR9RxjI</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2357471297</pqid></control><display><type>article</type><title>Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Cochrane Library</source><source>Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /></source><source>Web of Science - Social Sciences Citation Index – 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /></source><source>Alma/SFX Local Collection</source><creator>Carney, Tara ; Van Hout, Marie Claire ; Norman, Ian ; Dada, Siphokazi ; Siegfried, Nandi ; Parry, Charles DH ; Carney, Tara</creator><creatorcontrib>Carney, Tara ; Van Hout, Marie Claire ; Norman, Ian ; Dada, Siphokazi ; Siegfried, Nandi ; Parry, Charles DH ; Carney, Tara</creatorcontrib><description>Background
Medical treatment and detoxification from opiate disorders includes oral administration of opioid agonists. Dihydrocodeine (DHC) substitution treatment is typically low threshold and therefore has the capacity to reach wider groups of opiate users. Decisions to prescribe DHC to patients with less severe opiate disorders centre on its perceived safety, reduced toxicity, shorter half‐life and more rapid onset of action, and potential retention of patients. This review set out to investigate the effects of DHC in comparison to other pharmaceutical opioids and placebos in the detoxification and substitution of individuals with opiate use disorders.
Objectives
To investigate the effectiveness of DHC in reducing illicit opiate use and other health‐related outcomes among adults compared to other drugs or placebos used for detoxification or substitution therapy.
Search methods
In February 2019 we searched Cochrane Drugs and Alcohol's Specialised Register, CENTRAL, PubMed, Embase and Web of Science. We also searched for ongoing and unpublished studies via ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and Trialsjournal.com. All searches included non‐English language literature. We handsearched references of topic‐related systematic reviews and the included studies.
Selection criteria
We included randomised controlled trials that evaluated the effect of DHC for detoxification and maintenance substitution therapy for adolescent (aged 15 years and older) and adult illicit opiate users.
The primary outcomes were abstinence from illicit opiate use following detoxification or maintenance therapy measured by self‐report or urinalysis. The secondary outcomes were treatment retention and other health and behaviour outcomes.
Data collection and analysis
We followed the standard methodological procedures that are outlined by Cochrane. This includes the GRADE approach to appraise the quality of evidence.
Main results
We included three trials (in five articles) with 385 opiate‐using participants that measured outcomes at different follow‐up periods in this review. Two studies with 150 individuals compared DHC with buprenorphine for detoxification, and one study with 235 participants compared DHC to methadone for maintenance substitution therapy. We downgraded the quality of evidence mainly due to risk of bias and imprecision.
For the two studies that compared DHC to buprenorphine, we found low‐quality evidence of no significant difference between DHC and buprenorphine for detoxification at six‐month follow‐up (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.25 to 1.39; P = 0.23) in the meta‐analysis for the primary outcome of abstinence from illicit opiates. Similarly, low‐quality evidence indicated no difference for treatment retention (RR 1.29, 95% CI 0.99 to 1.68; P = 0.06).
In the single trial that compared DHC to methadone for maintenance substitution therapy, the evidence was also of low quality, and there may be no difference in effects between DHC and methadone for reported abstinence from illicit opiates (mean difference (MD) −0.01, 95% CI −0.31 to 0.29). For treatment retention at six months' follow‐up in this single trial, the RR calculated with an intention‐to‐treat analysis also indicated that there may be no difference between DHC and methadone (RR 1.04, 95% CI 0.94 to 1.16).
The studies that compared DHC to buprenorphine reported no serious adverse events, while the DHC versus methadone study reported one death due to methadone overdose.
Authors' conclusions
We found low‐quality evidence that DHC may be no more effective than other commonly used pharmacological interventions in reducing illicit opiate use. It is therefore premature to make any conclusive statements about the effectiveness of DHC, and it is suggested that further high‐quality studies are conducted, especially in low‐ to middle‐income countries.</description><identifier>ISSN: 1469-493X</identifier><identifier>ISSN: 1465-1858</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD012254.pub2</identifier><identifier>PMID: 32068247</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject><![CDATA[Analgesics, Opioid ; Analgesics, Opioid - therapeutic use ; Codeine ; Codeine - analogs & derivatives ; Codeine - therapeutic use ; Dextoxification ; General & Internal Medicine ; Humans ; Life Sciences & Biomedicine ; Maintenance ; Maintenance Chemotherapy ; Maintenance Chemotherapy - methods ; Medicine General & Introductory Medical Sciences ; Medicine, General & Internal ; Opiate Substitution Treatment ; Opiate Substitution Treatment - methods ; Opioid-Related Disorders - drug therapy ; Opioids abuse and dependence ; Opioids, opiates, heroin ; Opioid‐Related Disorders ; Pharmacological detoxification interventions ; Pharmacological maintenance interventions ; Randomized Controlled Trials as Topic ; Science & Technology ; Tobacco, drugs & alcohol]]></subject><ispartof>Cochrane database of systematic reviews, 2020-02, Vol.2020 (2), p.CD012254, Article 012254</ispartof><rights>Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>5</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000517176800003</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c4732-8170e1362a921220aaccfb146e6ceaa6bb8e89ce5ebf889fe7d5b2a28d0c460b3</citedby><cites>FETCH-LOGICAL-c4732-8170e1362a921220aaccfb146e6ceaa6bb8e89ce5ebf889fe7d5b2a28d0c460b3</cites><orcidid>0000-0001-5400-0565 ; 0000-0001-9787-2785</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,781,785,886,27929,27930,28253,28254</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32068247$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Carney, Tara</creatorcontrib><creatorcontrib>Van Hout, Marie Claire</creatorcontrib><creatorcontrib>Norman, Ian</creatorcontrib><creatorcontrib>Dada, Siphokazi</creatorcontrib><creatorcontrib>Siegfried, Nandi</creatorcontrib><creatorcontrib>Parry, Charles DH</creatorcontrib><creatorcontrib>Carney, Tara</creatorcontrib><title>Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders</title><title>Cochrane database of systematic reviews</title><addtitle>COCHRANE DB SYST REV</addtitle><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Medical treatment and detoxification from opiate disorders includes oral administration of opioid agonists. Dihydrocodeine (DHC) substitution treatment is typically low threshold and therefore has the capacity to reach wider groups of opiate users. Decisions to prescribe DHC to patients with less severe opiate disorders centre on its perceived safety, reduced toxicity, shorter half‐life and more rapid onset of action, and potential retention of patients. This review set out to investigate the effects of DHC in comparison to other pharmaceutical opioids and placebos in the detoxification and substitution of individuals with opiate use disorders.
Objectives
To investigate the effectiveness of DHC in reducing illicit opiate use and other health‐related outcomes among adults compared to other drugs or placebos used for detoxification or substitution therapy.
Search methods
In February 2019 we searched Cochrane Drugs and Alcohol's Specialised Register, CENTRAL, PubMed, Embase and Web of Science. We also searched for ongoing and unpublished studies via ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and Trialsjournal.com. All searches included non‐English language literature. We handsearched references of topic‐related systematic reviews and the included studies.
Selection criteria
We included randomised controlled trials that evaluated the effect of DHC for detoxification and maintenance substitution therapy for adolescent (aged 15 years and older) and adult illicit opiate users.
The primary outcomes were abstinence from illicit opiate use following detoxification or maintenance therapy measured by self‐report or urinalysis. The secondary outcomes were treatment retention and other health and behaviour outcomes.
Data collection and analysis
We followed the standard methodological procedures that are outlined by Cochrane. This includes the GRADE approach to appraise the quality of evidence.
Main results
We included three trials (in five articles) with 385 opiate‐using participants that measured outcomes at different follow‐up periods in this review. Two studies with 150 individuals compared DHC with buprenorphine for detoxification, and one study with 235 participants compared DHC to methadone for maintenance substitution therapy. We downgraded the quality of evidence mainly due to risk of bias and imprecision.
For the two studies that compared DHC to buprenorphine, we found low‐quality evidence of no significant difference between DHC and buprenorphine for detoxification at six‐month follow‐up (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.25 to 1.39; P = 0.23) in the meta‐analysis for the primary outcome of abstinence from illicit opiates. Similarly, low‐quality evidence indicated no difference for treatment retention (RR 1.29, 95% CI 0.99 to 1.68; P = 0.06).
In the single trial that compared DHC to methadone for maintenance substitution therapy, the evidence was also of low quality, and there may be no difference in effects between DHC and methadone for reported abstinence from illicit opiates (mean difference (MD) −0.01, 95% CI −0.31 to 0.29). For treatment retention at six months' follow‐up in this single trial, the RR calculated with an intention‐to‐treat analysis also indicated that there may be no difference between DHC and methadone (RR 1.04, 95% CI 0.94 to 1.16).
The studies that compared DHC to buprenorphine reported no serious adverse events, while the DHC versus methadone study reported one death due to methadone overdose.
Authors' conclusions
We found low‐quality evidence that DHC may be no more effective than other commonly used pharmacological interventions in reducing illicit opiate use. It is therefore premature to make any conclusive statements about the effectiveness of DHC, and it is suggested that further high‐quality studies are conducted, especially in low‐ to middle‐income countries.</description><subject>Analgesics, Opioid</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Codeine</subject><subject>Codeine - analogs & derivatives</subject><subject>Codeine - therapeutic use</subject><subject>Dextoxification</subject><subject>General & Internal Medicine</subject><subject>Humans</subject><subject>Life Sciences & Biomedicine</subject><subject>Maintenance</subject><subject>Maintenance Chemotherapy</subject><subject>Maintenance Chemotherapy - methods</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Medicine, General & Internal</subject><subject>Opiate Substitution Treatment</subject><subject>Opiate Substitution Treatment - methods</subject><subject>Opioid-Related Disorders - drug therapy</subject><subject>Opioids abuse and dependence</subject><subject>Opioids, opiates, heroin</subject><subject>Opioid‐Related Disorders</subject><subject>Pharmacological detoxification interventions</subject><subject>Pharmacological maintenance interventions</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Science & Technology</subject><subject>Tobacco, drugs & alcohol</subject><issn>1469-493X</issn><issn>1465-1858</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>AOWDO</sourceid><sourceid>ARHDP</sourceid><sourceid>EIF</sourceid><recordid>eNqNkduKFDEQhhtR3HX1FZZcCtJjkj4kfSNor-4KC94oeBfSSbVT0p2MSXrXeXszOwfUG4VACuqrw19_UVwyumKU8tesbhsmG7nqryjjvKlXm2Xgj4rzXaLcZR4_xF1Zd9XXs-JZjN8prdqOi6fFWcVpK3ktzgt7heutDd54C-iAjD4QC8n_xBGNTugd0c6SWaNL4LQzQFIAnWZwiaDLz-Id2kVPkdxjWhO_QZ2ALBGIxeiDhRCfF0_GDMCLw39RfPnw_nN_U95-uv7Yv70tTS0qXkomKLCq5brjWRPV2phxyCKgNaB1OwwSZGeggWGUshtB2GbgmktLTd3Soboo3uz75lvMYE3eMehJbQLOOmyV16j-zDhcq2_-TgnKBecsN3h5aBD8jwViUjNGA9OkHfglKl41ohaMdyKj7R41wccYYDyNYVTtLFJHi9TRot1wngsvf1_yVHb0JANyD9zD4MdoEPLVTxiltGGCiVbmiFY9pgeXer-4lEtf_X9ppt8daJxgq4w365CF_kPAX3J-AR9RxjI</recordid><startdate>20200218</startdate><enddate>20200218</enddate><creator>Carney, Tara</creator><creator>Van Hout, Marie Claire</creator><creator>Norman, Ian</creator><creator>Dada, Siphokazi</creator><creator>Siegfried, Nandi</creator><creator>Parry, Charles DH</creator><creator>Carney, Tara</creator><general>John Wiley & Sons, Ltd</general><general>Wiley</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>17B</scope><scope>AOWDO</scope><scope>ARHDP</scope><scope>BLEPL</scope><scope>DTL</scope><scope>DVR</scope><scope>EGQ</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5400-0565</orcidid><orcidid>https://orcid.org/0000-0001-9787-2785</orcidid></search><sort><creationdate>20200218</creationdate><title>Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders</title><author>Carney, Tara ; Van Hout, Marie Claire ; Norman, Ian ; Dada, Siphokazi ; Siegfried, Nandi ; Parry, Charles DH ; Carney, Tara</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4732-8170e1362a921220aaccfb146e6ceaa6bb8e89ce5ebf889fe7d5b2a28d0c460b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Analgesics, Opioid</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Codeine</topic><topic>Codeine - analogs & derivatives</topic><topic>Codeine - therapeutic use</topic><topic>Dextoxification</topic><topic>General & Internal Medicine</topic><topic>Humans</topic><topic>Life Sciences & Biomedicine</topic><topic>Maintenance</topic><topic>Maintenance Chemotherapy</topic><topic>Maintenance Chemotherapy - methods</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Medicine, General & Internal</topic><topic>Opiate Substitution Treatment</topic><topic>Opiate Substitution Treatment - methods</topic><topic>Opioid-Related Disorders - drug therapy</topic><topic>Opioids abuse and dependence</topic><topic>Opioids, opiates, heroin</topic><topic>Opioid‐Related Disorders</topic><topic>Pharmacological detoxification interventions</topic><topic>Pharmacological maintenance interventions</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Science & Technology</topic><topic>Tobacco, drugs & alcohol</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Carney, Tara</creatorcontrib><creatorcontrib>Van Hout, Marie Claire</creatorcontrib><creatorcontrib>Norman, Ian</creatorcontrib><creatorcontrib>Dada, Siphokazi</creatorcontrib><creatorcontrib>Siegfried, Nandi</creatorcontrib><creatorcontrib>Parry, Charles DH</creatorcontrib><creatorcontrib>Carney, Tara</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Web of Knowledge</collection><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science - Social Sciences Citation Index – 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Social Sciences Citation Index</collection><collection>Web of Science Primary (SCIE, SSCI & AHCI)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Carney, Tara</au><au>Van Hout, Marie Claire</au><au>Norman, Ian</au><au>Dada, Siphokazi</au><au>Siegfried, Nandi</au><au>Parry, Charles DH</au><au>Carney, Tara</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders</atitle><jtitle>Cochrane database of systematic reviews</jtitle><stitle>COCHRANE DB SYST REV</stitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2020-02-18</date><risdate>2020</risdate><volume>2020</volume><issue>2</issue><spage>CD012254</spage><pages>CD012254-</pages><artnum>012254</artnum><issn>1469-493X</issn><issn>1465-1858</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Medical treatment and detoxification from opiate disorders includes oral administration of opioid agonists. Dihydrocodeine (DHC) substitution treatment is typically low threshold and therefore has the capacity to reach wider groups of opiate users. Decisions to prescribe DHC to patients with less severe opiate disorders centre on its perceived safety, reduced toxicity, shorter half‐life and more rapid onset of action, and potential retention of patients. This review set out to investigate the effects of DHC in comparison to other pharmaceutical opioids and placebos in the detoxification and substitution of individuals with opiate use disorders.
Objectives
To investigate the effectiveness of DHC in reducing illicit opiate use and other health‐related outcomes among adults compared to other drugs or placebos used for detoxification or substitution therapy.
Search methods
In February 2019 we searched Cochrane Drugs and Alcohol's Specialised Register, CENTRAL, PubMed, Embase and Web of Science. We also searched for ongoing and unpublished studies via ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and Trialsjournal.com. All searches included non‐English language literature. We handsearched references of topic‐related systematic reviews and the included studies.
Selection criteria
We included randomised controlled trials that evaluated the effect of DHC for detoxification and maintenance substitution therapy for adolescent (aged 15 years and older) and adult illicit opiate users.
The primary outcomes were abstinence from illicit opiate use following detoxification or maintenance therapy measured by self‐report or urinalysis. The secondary outcomes were treatment retention and other health and behaviour outcomes.
Data collection and analysis
We followed the standard methodological procedures that are outlined by Cochrane. This includes the GRADE approach to appraise the quality of evidence.
Main results
We included three trials (in five articles) with 385 opiate‐using participants that measured outcomes at different follow‐up periods in this review. Two studies with 150 individuals compared DHC with buprenorphine for detoxification, and one study with 235 participants compared DHC to methadone for maintenance substitution therapy. We downgraded the quality of evidence mainly due to risk of bias and imprecision.
For the two studies that compared DHC to buprenorphine, we found low‐quality evidence of no significant difference between DHC and buprenorphine for detoxification at six‐month follow‐up (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.25 to 1.39; P = 0.23) in the meta‐analysis for the primary outcome of abstinence from illicit opiates. Similarly, low‐quality evidence indicated no difference for treatment retention (RR 1.29, 95% CI 0.99 to 1.68; P = 0.06).
In the single trial that compared DHC to methadone for maintenance substitution therapy, the evidence was also of low quality, and there may be no difference in effects between DHC and methadone for reported abstinence from illicit opiates (mean difference (MD) −0.01, 95% CI −0.31 to 0.29). For treatment retention at six months' follow‐up in this single trial, the RR calculated with an intention‐to‐treat analysis also indicated that there may be no difference between DHC and methadone (RR 1.04, 95% CI 0.94 to 1.16).
The studies that compared DHC to buprenorphine reported no serious adverse events, while the DHC versus methadone study reported one death due to methadone overdose.
Authors' conclusions
We found low‐quality evidence that DHC may be no more effective than other commonly used pharmacological interventions in reducing illicit opiate use. It is therefore premature to make any conclusive statements about the effectiveness of DHC, and it is suggested that further high‐quality studies are conducted, especially in low‐ to middle‐income countries.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>32068247</pmid><doi>10.1002/14651858.CD012254.pub2</doi><tpages>40</tpages><orcidid>https://orcid.org/0000-0001-5400-0565</orcidid><orcidid>https://orcid.org/0000-0001-9787-2785</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1469-493X |
| ispartof | Cochrane database of systematic reviews, 2020-02, Vol.2020 (2), p.CD012254, Article 012254 |
| issn | 1469-493X 1465-1858 1465-1858 1469-493X |
| language | eng |
| recordid | cdi_pubmed_primary_32068247 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Cochrane Library; Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; Web of Science - Social Sciences Citation Index – 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; Alma/SFX Local Collection |
| subjects | Analgesics, Opioid Analgesics, Opioid - therapeutic use Codeine Codeine - analogs & derivatives Codeine - therapeutic use Dextoxification General & Internal Medicine Humans Life Sciences & Biomedicine Maintenance Maintenance Chemotherapy Maintenance Chemotherapy - methods Medicine General & Introductory Medical Sciences Medicine, General & Internal Opiate Substitution Treatment Opiate Substitution Treatment - methods Opioid-Related Disorders - drug therapy Opioids abuse and dependence Opioids, opiates, heroin Opioid‐Related Disorders Pharmacological detoxification interventions Pharmacological maintenance interventions Randomized Controlled Trials as Topic Science & Technology Tobacco, drugs & alcohol |
| title | Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-15T06%3A29%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Dihydrocodeine%20for%20detoxification%20and%20maintenance%20treatment%20in%20individuals%20with%20opiate%20use%20disorders&rft.jtitle=Cochrane%20database%20of%20systematic%20reviews&rft.au=Carney,%20Tara&rft.date=2020-02-18&rft.volume=2020&rft.issue=2&rft.spage=CD012254&rft.pages=CD012254-&rft.artnum=012254&rft.issn=1469-493X&rft.eissn=1465-1858&rft_id=info:doi/10.1002/14651858.CD012254.pub2&rft_dat=%3Cproquest_pubme%3E2357471297%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2357471297&rft_id=info:pmid/32068247&rfr_iscdi=true |