From the Guidelines
Best Treatment for Acute Opioid Withdrawal
The best treatment for acute opioid withdrawal is medication-assisted therapy with buprenorphine or methadone, alongside symptomatic support 1. Buprenorphine is often preferred due to its safer side effect profile and easier management.
Treatment Regimen
A typical regimen starts with buprenorphine 2-4 mg on the first day, titrated up to 8-16 mg as needed and tolerated, with the goal of stabilizing the patient within 3 days.
Adjunctive Medications
Additionally, adjunctive medications such as:
- clonidine 0.1-0.2 mg every 4-6 hours as needed for anxiety and hypertension
- loperamide 2-4 mg every 4-6 hours as needed for diarrhea can be used to manage withdrawal symptoms 1.
Treatment Duration
The treatment duration varies depending on the individual's response and the severity of withdrawal but typically lasts 7-14 days.
Monitoring and Adjustment
It's crucial to monitor the patient closely and adjust the treatment plan as necessary to ensure safe and effective management of withdrawal symptoms 1.
Key Considerations
- Buprenorphine should be administered only to patients in active opioid withdrawal as confirmed by history and physical examination 1.
- Particular care is required when transitioning from methadone to buprenorphine because of the risk of severe and prolonged precipitated withdrawal 1.
From the Research
Treatment Options for Acute Opioid Withdrawal
- Buprenorphine is a commonly used medication for managing opioid withdrawal, with studies suggesting it can be effective in reducing the severity of withdrawal symptoms 2, 3, 4.
- Methadone is another medication used to treat opioid withdrawal, and can be administered in a bridge clinic setting to facilitate linkage to an opioid treatment program 5.
- Buprenorphine has been shown to be more effective than clonidine or lofexidine in managing opioid withdrawal, with a lower average withdrawal score and higher treatment completion rates 3.
- The use of buprenorphine in the emergency department setting has been proposed as an approach to initiating treatment for opioid withdrawal, with a step-by-step approach to administration and a multimodal medication-assisted treatment plan 6.
Comparison of Buprenorphine and Methadone
- Studies have suggested that buprenorphine and methadone are equally effective in managing opioid withdrawal, although the pattern of withdrawal experienced may differ 3.
- Buprenorphine may have an advantage over methadone in terms of its potential to support transition to naltrexone treatment, although further research is needed to confirm this 3.
Administration and Dosage
- Buprenorphine can be administered via various routes, including sublingual, transbuccal, transdermal, subdermal, and parenteral routes 6.
- The dosage of buprenorphine used to treat opioid withdrawal can vary, with some studies suggesting that rapid increases in dose can be effective in managing precipitated withdrawal 2.
- Methadone can be administered in a single observed oral dose, with the potential for repeat dosing as needed 5.