Non-opioid Protocol for Opioid Detoxification and Transition to Antagonist Treatment

Abstract

Objective: The clinical effectiveness of a novel non-opioid and benzodiazepine-free protocol was compared to a standardized buprenorphine/naloxone (bup/nx) taper protocol for opioid detoxification and transition to subsequent relapse prevention strategies. Methods: Retrospective chart review of DSM IV diagnosed opioid-dependent patients admitted for inpatient detoxification examined differences between 84 subjects that received a non-opioid protocol (treated with a scheduled 4-day regimen of tizanidine, hydroxyzine and gabapentin) and 40 subjects that received a 4-day bup/nx taper protocol. Both groups received ancillary medications and routine counseling. Primary outcomes were completion of detoxification, and facilitation to further chemical dependency treatment. Secondary outcomes included length of hospital stay, Clinical Opiate Withdrawal Scale (COWS) scores, ancillary medication use, adverse effects, and initiation of injectable ER naltrexone treatment. Results: Non-opioid protocol subjects, as compared to subjects receiving the bup/nx protocol, had greater completion of detoxification (94% vs 80%, P= .026), and greater facilitation to further chemical dependency treatment (85% vs 63%, P = .006). The non- opioid protocol had a lower incidence of bradycardia (44% vs 65%, P = .035), and lower mean COWS scores on day 1 (3.3 vs 4.8; P < .001). No significant differences were observed between the two protocols for the average COWS scores on day 2, 3 and 4; rates of asymptomatic and symptomatic hypotension; reported adverse effects; length of hospital stay; and ancillary medication use (P > .05). In the non-opioid protocol 27 (32%) patients pursued transition to extended release naltrexone and 24 (89%) received the injection prior to hospital discharge. Conclusion: This retrospective, non-randomized, case review study demonstrates the efficacy of a novel, non-opioid detoxification protocol using scheduled tizanidine, gabapentin and hydroxyzine for management of opioid withdrawal during the phase between cessation of opioids and initiation of relapse prevention strategies, including transition to injectable ER naltrexone.