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Methadone at tapered doses for the management of opioid withdrawal

2005; Cochrane; Linguagem: Inglês

10.1002/14651858.cd003409.pub3

1469-493X

Laura Amato, Marina Davoli, Silvia Minozzi, Robert Ali, Marica Ferri,

Prenatal Substance Exposure Effects

Background Despite widespread use in many countries the evidence of tapered methadone's efficacy in managing opioid withdrawal has not been systematically evaluated. Objectives To evaluate the effectiveness of tapered methadone compared with other detoxification treatments and placebo in managing opioid withdrawal on completion of detoxification and relapse rate. Search methods We searched: Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2008), PubMed (January 1966 to December 2007), EMBASE (January 1988 to December 2007), CINAHL (2003‐ December 2007), PsycINFO (January 1985 to December 2004), reference lists of articles. Selection criteria All randomised controlled trials which focus on the use of tapered methadone versus all other pharmacological detoxification treatments or placebo for the treatment of opiate withdrawal. Data collection and analysis Two reviewers assessed the included studies. Any doubt about how to rate the studies were resolved by discussion with a third reviewer. Study quality was assessed according to the criteria indicated in Cochrane Reviews Handbook 4.2. Main results Twenty trials involving 1907 people were included. Comparing methadone versus any other pharmacological treatment we observed no clinical difference between the two treatments in terms of completion of treatment, relative risk (RR) 1.08 (95% CI 0.95 to 1.24) and results at follow‐up RR 1.17 (95% CI 0.72 to 1.92). It was impossible to pool data for the other outcomes but the results of the studies did not show significant differences between the considered treatments. These results were confirmed also when we considered the single comparisons: methadone with: adrenergic agonists (11 studies), other opioid agonists (five studies), anxiolytic (two studies). Comparing methadone with placebo (two studies) more severe withdrawal and more drop outs were found in the placebo group. The results indicate that the medications used in the included studies are similar in terms of overall effectiveness, although symptoms experienced by participants differed according to the medication used and the program adopted. Authors' conclusions Data from literature are hardly comparable; programs vary widely with regard to the assessment of outcome measures, impairing the application of meta‐analysis. The studies included in this review confirm that slow tapering with temporary substitution of long acting opioids, can reduce withdrawal severity. Nevertheless the majority of patients relapsed to heroin use.