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Home > Pharmacological therapies for maintenance treatments of opium dependence.

Rahimi-Movaghar, Afarin and Amin-Esmaeili, Masoumeh and Hefazi, Mitra and Yousefi-Nooraie, Reza [The Cochrane Library] . (2013) Pharmacological therapies for maintenance treatments of opium dependence. London: John Wiley & Sons, Ltd. Cochrane Database of Systematic Reviews (1) Art. No.: CD007775. DOI: 10.1002/14651858.CD007775.pub2.

URL: http://onlinelibrary.wiley.com/doi/10.1002/1465185...

Opium is obtained from the unripe seed capsules of the poppy plant. Opium is usually used by smoking or by swallowing to create a feeling of euphoria, to provide pleasure or as an analgesic or hypnotic. Cultural attitudes affect the patterns of opioid use among different countries. In the Middle East and south east Asia, opium is used in many cases in social settings and the users do not suffer from considerable social dysfunction. It is used occasionally and mainly in male gatherings but regular use can cause dependence. Opium users have a more stable life style than heroin users and, of those who come for treatment, a higher proportion are married and live with their family.

Stopping opium use gives rise to a mild intensity opiate withdrawal syndrome. The physical signs of withdrawal syndrome usually stop after 14 days; but a protracted syndrome that includes reduced well-being, malaise and periodic strong cravings can continue for months. Completion of withdrawal and remaining abstinent is difficult and opium dependents often relapse if treatment does not continue after completion of withdrawal.

When the type of opioid used is less harmful than heroin, as with opium, there is a question as to what type of treatment or maintenance is most effective; detoxification from opium is short-lasting and better tolerated than detoxification from methadone.

Three randomised controlled trials involving 870 opium dependents were included in the review. In two of the trials different doses of the semi-synthetic opioid buprenorphine were compared. The higher doses of buprenorphine (4 mg/day and 8 mg/day, respectively) increased the probability of retention in treatment. The studies had a high risk of bias. In the third trial baclofen (an agonist of GABA-B receptors) was compared with placebo for maintenance treatment after a process of detoxification. Only 27 of the 40 participants were opium dependent and there was a trend for increased retention in treatment. Important outcomes such as drug use and drug side effects were not assessed.

Overall, the results from three trials are not sufficient to form a view on the effectiveness of any pharmacological intervention for opium dependence. Buprenorphine has partial agonist opioid activity and appears to be well-tolerated with minor side effects. However, buprenorphine abuse has emerged and been recognised as a problem in many Asian countries in the last two decades. Its use by injection is also quite common.


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