Buprenorphine for Opioid Detoxification

Objectives To review the pharmacotherapy of opioid dependence focusing on detoxification using buprenorphine, a partial μ-opioid agonist. Methods Based on a literature review of recent studies, general approaches to the use of buprenorphine and the associated success are summarized. Results Like methadone, longer duration of buprenorphine stabilization and associated psychosocial treatment is associated with a better outcome and less relapse. However, a simple detoxification can be done by gradually reducing the dose of buprenorphine from a standard starting dose of 4–8 mg daily over a period of a week to as long as a month. When a transition to the antagonist naltrexone is desired, better success and greater efficiency can be obtained by combining clonidine with naltrexone to precipitate buprenorphine withdrawal than by using a dosage tapering. With a rapid clonidine/naltrexone approach, the induction on to naltrexone can be completed in as little as 1 day. Conclusions Buprenorphine can be an effective agent for opiate detoxification and transition to relapse prevention treatment using naltrexone. Ongoing work should make a once-monthly depot form of naltrexone available within a couple of years, thereby facilitating naltrexone adherence in former opiate dependent patients.