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Home > Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders.

Carney, Tara and Van Hout, Marie Claire and Norman, Ian and Dada, SiphoKazi and Siegfried, Nandi and Parry, Charles DH (2020) Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders. Cochrane Database of Systematic Reviews, (2), . Art. No.: CD012254. DOI: 10.1002/14651858.CD012254.pub2.

External website: https://www.cochranelibrary.com/cdsr/doi/10.1002/1...


Review question: We reviewed evidence on the effects of dihydrocodeine (DHC) to reduce illegal substance use among adolescents older than 15 years and adults.

Background: The use of illegal substances such as heroin is a world‐wide problem, and can lead to other issues. What is especially concerning is the far‐reaching health consequences of this substance use. This includes high numbers of deaths due to heroin and other opiates from overdoses, and the fact that it is a risk factor for Hepatitis C and HIV, particularly among those who inject their drugs.

We wanted to learn if DHC has a positive effect on decreasing this kind of drug use among those adolescents and adults. DHC is a type of opiate that is codeine‐based.

Search date: The evidence is current to February 2019.

Study characteristics: We included three studies in this review with 385 participants in total with follow‐up periods of different length. Two studies with 150 participants compared DHC to buprenorphine for detoxification (managing physical symptoms of withdrawal), while one study with 235 individuals compared DHC to methadone for maintenance substitution therapy (providing legal substance to reduce risk behaviour and other harm related to drug use over a longer period). All the studies took place in the UK.

Our primary outcome was abstinence or no longer using illegal substances; our secondary outcomes were completing treatment, as well as health‐related consequences of substance use, and other behaviours often linked to substance use such as illegal activity. We also assessed the safety of DHC.

Key results: For detoxification from illegal substances such as heroin, DHC may not work any better than buprenorphine in reducing substance use, keeping individuals in treatment and other behaviours. The pattern stayed the same for follow‐up appointments.

For maintenance treatment, DHC also may not work better than methadone in reducing substance use or any of the secondary outcomes, but participants may be more likely to stay in treatment. This finding remained the same across longer follow‐up periods as well.

The only adverse event reported was one death from a methadone overdose in the study that compared DHC with methadone as maintenance therapy.

The pattern of results indicates that individuals who received DHC generally may not do better in reducing their substance use, completing treatment or other measures of substance‐related behaviours than those that received other types of medication. However it is premature to make definitive statements about the efficacy of DHC for reducing illegal substance use, due to the low quality of evidence.

Quality of evidence: Overall, the evidence was of low quality. There were two major issues across the studies. There was no blinding of the participants or those who assessed the outcomes, so that they were aware of which group they were in. There was also a high level of participants who dropped out of two of the studies.

Item Type
Article
Publication Type
International, Open Access, Review
Drug Type
Opioid
Intervention Type
Drug therapy, Treatment method, Harm reduction
Date
February 2020
Identification #
Art. No.: CD012254. DOI: 10.1002/14651858.CD012254.pub2
Number
2
EndNote

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