Medicine by the Numbers

A Collaboration of TheNNT.com and AFP

Alpha-adrenergic Agonists for the Management of Opioid Withdrawal

 

Am Fam Physician. 2017 Jan 1;95(1):online.

image

View/Print Table

ALPHA-ADRENERGIC AGONISTS FOR THE MANAGEMENT OF OPIOID WITHDRAWAL

BenefitsHarms

NNT = 3 to prevent one episode of severe withdrawal

Uncertain

NNT = 4 for treatment completion


NNT = number needed to treat.

ALPHA-ADRENERGIC AGONISTS FOR THE MANAGEMENT OF OPIOID WITHDRAWAL

BenefitsHarms

NNT = 3 to prevent one episode of severe withdrawal

Uncertain

NNT = 4 for treatment completion


NNT = number needed to treat.

Details for This Review

Study Population: Patients undergoing managed withdrawal treatment for opioid dependence, spanning inpatient and outpatient settings

Efficacy End Points: Severe withdrawal symptoms (Modified Himmelsbach Opiate Withdrawal Scale; Objective Opioid Withdrawal Scale), treatment completion

Harm End Points: Hypotension, intense opioid cravings, uncomfortable symptoms—dizziness, drowsiness, fatigue, insomnia, and dry mouth

Narrative: Methadone is the most commonly used medication for management of withdrawal from opioids.1 Several factors (drug prescribing regulations, dislike for the prolonged nature of methadone withdrawal, and desire to find alternatives for opiate treatment) led to the investigation of alpha-adrenergic agonists (AAAs) to decrease the severity of withdrawal symptoms.2

A Cochrane review, including 26 randomized controlled trials totaling 1,728 participants, sought to compare AAAs vs. methadone and AAAs vs. placebo in effectively decreasing severe withdrawal symptoms as well as increasing the number of participants completing treatment.3 Investigators found moderate-quality evidence that AAAs were more effective than placebo in decreasing severe withdrawal symptoms with increased likelihood of treatment completion. Pooled analysis data of moderate-quality evidence revealed that 19% of the participants in the AAA group experienced severe withdrawal compared with 59% of those receiving placebo (number needed to treat [NNT] = 3; 95% confidence interval

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Substance Abuse and Mental Health Services Administration. Medication-assisted treatment for opioid addiction in opioid treatment programs. http://www.ncbi.nlm.nih.gov/books/NBK64164/pdf/Bookshelf_NBK64164.pdf. Accessed September 9, 2016....

2. Farrell M. Opiate withdrawal. Addiction. 1994;89(11):1471–1475.

3. Gowing L, Farrell M, Ali R, White JM. Alpha2-adrenergic agonists for the management of opioid withdrawal. Cochrane Database Syst Rev. 2016;(5):CD002024.

4. U.S. Department of Veterans Affairs/U.S. Department of Defense. Tapering and discontinuing opioids. http://www.healthquality.va.gov/guidelines/Pain/cot/OpioidTaperingFactSheet23May2013v1.pdf. Accessed September 9, 2016.


 

Copyright © 2017 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


May 1, 2017

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article