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Sigmon’s JAMA Psychiatry Study Evaluates Outpatient Detoxification in Prescription Opioid Abusers

Stacey Sigmon, Ph.D.
UVM Assistant Professor of Psychiatry Stacey Sigmon, Ph.D.

New study findings show that patients addicted to prescription painkillers may respond favorably to a carefully-crafted, four-week buprenorphine taper plus naltrexone maintenance treatment. These clinical trial results were reported by Stacey Sigmon, Ph.D., University of Vermont associate professor of psychiatry, and colleagues and published in the October 23, 2013 Online First edition of the journal JAMA Psychiatry.

Abuse of prescription opioid drugs, such as oxycodone, hydrocodone and hydromorphone, are a serious public health problem. Since 1990, drug overdose death rates have more than tripled in the U.S., with nearly three out of four prescription drug overdoses caused by prescription painkillers, according to the Centers for Disease Control and Prevention.

Sigmon and the research team conducted a 12-week randomized clinical trial in an outpatient research clinic with 70 prescription opioid-dependent patients to compare the efficacy of varying durations of outpatient detoxification. After a two-week period of stabilization on buprenorphine, an opioid agonist medication, patients were randomized to gradually reduce the dose of the buprenorphine over one, two or four weeks followed by treatment with naltrexone, a drug that blocks opioid receptors and prevents a return to opioid dependence. Patients in all groups also received individual behavioral therapy, HIV and hepatitis education, and urinalysis monitoring.

The study findings indicate that opioid abstinence was greater in patients receiving the four-week taper compared with the two- and one-week taper conditions. These results suggest that a meaningful subset of prescription opioid abusers may respond favorably to outpatient treatment with buprenorphine detoxification in combination with naltrexone and behavioral therapy, say Sigmon and the study’s authors.

“Additional controlled studies are needed to better understand the parameters of efficacious treatments for prescription opioid dependence, as well as to identify the individuals for whom brief versus longer-term treatments are warranted,” the authors conclude.

(This article was adapted from a news release produced by JAMA Network Media Relations.)