Buprenorphine Beats Tramadol as Heroin Detox

BOCA RATON, FLA. – Not all agents available to detoxify a person with a heroin addiction are created equal.

In a prospective comparison study, people who took buprenorphine experienced significantly fewer withdrawal symptoms and fewer serious adverse events over 10 days, compared with detoxification with tramadol.

Previous retrospective studies showed that buprenorphine was more effective than tramadol for acute heroin withdrawal, Dr. Jatinder M. Chawla said (Am. J. Addict. 2006;15:186-91; J. Addict. Dis. 2003;22:5-12). However, "there are some problems with buprenorphine," such as more abuse potential and a greater risk for respiratory depression, compared with tramadol, said Dr. Chawla, a psychiatry resident at SUNY Downstate Medical Center in Brooklyn, N.Y.

Also, tramadol is easier to administer in an outpatient setting because it’s an oral, nonscheduled medication compared with the sublingual, schedule III buprenorphine.

"We wanted to look at this in a prospective study," Dr. Chawla said in an interview at the annual meeting of the New Clinical Drug Evaluation Unit, sponsored by the National Institute of Mental Health.

Dr. Chawla and his associates assessed 62 men with a diagnosis of opiate dependence syndrome who had been admitted to the National Drug Dependence Treatment Centre in New Delhi, India. They were equally randomized to 10 days of buprenorphine or tramadol. Participants were aged 20-45 years. In all, 39 patients completed the 10-day study and were assessed further. Retention was not significantly different, with 21 buprenorphine and 18 tramadol patients remaining until study end.

No significant differences were found between groups in baseline Addiction Severity Index score; mean age of initiation of heroin use; duration of daily use; or average intake of heroin in the past month.

However, the researchers did find significant differences on the Subjective (SOWS) and Objective Opioid Withdrawal Scale (OOWS) scores. For example, the mean SOWS score was significantly lower in the buprenorphine group on the second, third, and ninth days of detoxification (suggesting greater efficacy). In addition, the mean OOWS score was significantly lower on days 2 and 3 in the buprenorphine group, compared with the tramadol group.

Participants also completed a visual analog scale daily to rate their satisfaction with treatment. Again, on days 2 and 3 of detoxification, people taking buprenorphine rated their satisfaction significantly higher than those taking tramadol.

Three patients in the tramadol group experienced seizures. "Tramadol has the risk of inducing seizures at higher doses," Dr. Chawla said. The seizures occurred on days 4 and 6, when drug was tapered up to a higher dose, he added.

Nausea and dizziness also were reported by people in the tramadol group. Headache, drowsiness, and dizziness were the most common adverse event reports in the buprenorphine group.

Despite these findings, Dr. Chawla said that tramadol still has advantages over buprenorphine and is not absolutely contraindicated. Additional caution is warranted for people with a history of seizures. Tramadol could be an option for patients with mild to moderate heroin dependence who are at risk of becoming addicted to buprenorphine, he said. In addition, a lower dose of tramadol could potentially minimize adverse events.

A small sample size and data from a single center are potential limitations of the study, Dr. Chawla said.

The study was unfunded. Dr. Chawla received a New Investigator Award at the NCDEU meeting for this study. He said he had no relevant financial disclosures.

BOCA RATON, FLA. – Not all agents available to detoxify a person with a heroin addiction are created equal.

In a prospective comparison study, people who took buprenorphine experienced significantly fewer withdrawal symptoms and fewer serious adverse events over 10 days, compared with detoxification with tramadol.

Previous retrospective studies showed that buprenorphine was more effective than tramadol for acute heroin withdrawal, Dr. Jatinder M. Chawla said (Am. J. Addict. 2006;15:186-91; J. Addict. Dis. 2003;22:5-12). However, "there are some problems with buprenorphine," such as more abuse potential and a greater risk for respiratory depression, compared with tramadol, said Dr. Chawla, a psychiatry resident at SUNY Downstate Medical Center in Brooklyn, N.Y.

Also, tramadol is easier to administer in an outpatient setting because it’s an oral, nonscheduled medication compared with the sublingual, schedule III buprenorphine.

"We wanted to look at this in a prospective study," Dr. Chawla said in an interview at the annual meeting of the New Clinical Drug Evaluation Unit, sponsored by the National Institute of Mental Health.

Dr. Chawla and his associates assessed 62 men with a diagnosis of opiate dependence syndrome who had been admitted to the National Drug Dependence Treatment Centre in New Delhi, India. They were equally randomized to 10 days of buprenorphine or tramadol. Participants were aged 20-45 years. In all, 39 patients completed the 10-day study and were assessed further. Retention was not significantly different, with 21 buprenorphine and 18 tramadol patients remaining until study end.

No significant differences were found between groups in baseline Addiction Severity Index score; mean age of initiation of heroin use; duration of daily use; or average intake of heroin in the past month.

However, the researchers did find significant differences on the Subjective (SOWS) and Objective Opioid Withdrawal Scale (OOWS) scores. For example, the mean SOWS score was significantly lower in the buprenorphine group on the second, third, and ninth days of detoxification (suggesting greater efficacy). In addition, the mean OOWS score was significantly lower on days 2 and 3 in the buprenorphine group, compared with the tramadol group.

Participants also completed a visual analog scale daily to rate their satisfaction with treatment. Again, on days 2 and 3 of detoxification, people taking buprenorphine rated their satisfaction significantly higher than those taking tramadol.

Three patients in the tramadol group experienced seizures. "Tramadol has the risk of inducing seizures at higher doses," Dr. Chawla said. The seizures occurred on days 4 and 6, when drug was tapered up to a higher dose, he added.

Nausea and dizziness also were reported by people in the tramadol group. Headache, drowsiness, and dizziness were the most common adverse event reports in the buprenorphine group.

Despite these findings, Dr. Chawla said that tramadol still has advantages over buprenorphine and is not absolutely contraindicated. Additional caution is warranted for people with a history of seizures. Tramadol could be an option for patients with mild to moderate heroin dependence who are at risk of becoming addicted to buprenorphine, he said. In addition, a lower dose of tramadol could potentially minimize adverse events.

A small sample size and data from a single center are potential limitations of the study, Dr. Chawla said.

The study was unfunded. Dr. Chawla received a New Investigator Award at the NCDEU meeting for this study. He said he had no relevant financial disclosures.

BOCA RATON, FLA. – Not all agents available to detoxify a person with a heroin addiction are created equal.

In a prospective comparison study, people who took buprenorphine experienced significantly fewer withdrawal symptoms and fewer serious adverse events over 10 days, compared with detoxification with tramadol.

Previous retrospective studies showed that buprenorphine was more effective than tramadol for acute heroin withdrawal, Dr. Jatinder M. Chawla said (Am. J. Addict. 2006;15:186-91; J. Addict. Dis. 2003;22:5-12). However, "there are some problems with buprenorphine," such as more abuse potential and a greater risk for respiratory depression, compared with tramadol, said Dr. Chawla, a psychiatry resident at SUNY Downstate Medical Center in Brooklyn, N.Y.

Also, tramadol is easier to administer in an outpatient setting because it’s an oral, nonscheduled medication compared with the sublingual, schedule III buprenorphine.

"We wanted to look at this in a prospective study," Dr. Chawla said in an interview at the annual meeting of the New Clinical Drug Evaluation Unit, sponsored by the National Institute of Mental Health.

Dr. Chawla and his associates assessed 62 men with a diagnosis of opiate dependence syndrome who had been admitted to the National Drug Dependence Treatment Centre in New Delhi, India. They were equally randomized to 10 days of buprenorphine or tramadol. Participants were aged 20-45 years. In all, 39 patients completed the 10-day study and were assessed further. Retention was not significantly different, with 21 buprenorphine and 18 tramadol patients remaining until study end.

No significant differences were found between groups in baseline Addiction Severity Index score; mean age of initiation of heroin use; duration of daily use; or average intake of heroin in the past month.

However, the researchers did find significant differences on the Subjective (SOWS) and Objective Opioid Withdrawal Scale (OOWS) scores. For example, the mean SOWS score was significantly lower in the buprenorphine group on the second, third, and ninth days of detoxification (suggesting greater efficacy). In addition, the mean OOWS score was significantly lower on days 2 and 3 in the buprenorphine group, compared with the tramadol group.

Participants also completed a visual analog scale daily to rate their satisfaction with treatment. Again, on days 2 and 3 of detoxification, people taking buprenorphine rated their satisfaction significantly higher than those taking tramadol.

Three patients in the tramadol group experienced seizures. "Tramadol has the risk of inducing seizures at higher doses," Dr. Chawla said. The seizures occurred on days 4 and 6, when drug was tapered up to a higher dose, he added.

Nausea and dizziness also were reported by people in the tramadol group. Headache, drowsiness, and dizziness were the most common adverse event reports in the buprenorphine group.

Despite these findings, Dr. Chawla said that tramadol still has advantages over buprenorphine and is not absolutely contraindicated. Additional caution is warranted for people with a history of seizures. Tramadol could be an option for patients with mild to moderate heroin dependence who are at risk of becoming addicted to buprenorphine, he said. In addition, a lower dose of tramadol could potentially minimize adverse events.

A small sample size and data from a single center are potential limitations of the study, Dr. Chawla said.

The study was unfunded. Dr. Chawla received a New Investigator Award at the NCDEU meeting for this study. He said he had no relevant financial disclosures.