Gregory Rudolf
American Board of Addiction Medicine, USA
Title: Buprenorphine in the treatment of opioid-induced hyperalgesia
Biography
Biography: Gregory Rudolf
Abstract
Background: Th e clinical eff ectiveness of a novel non-opioid and benzodiazepine-free protocol was compared to a standardized
buprenorphine/naloxone (bup/nx) taper protocol for opioid medically supervised withdrawal and transition to subsequent relapse
prevention strategies.
Methods: A retrospective chart review of DSM-IV diagnosed opioid-dependent patients admitted for inpatient medically supervised
withdrawal examined diff erences between 84 non-opioid protocol subjects (treated with scheduled 4-day tizanidine, hydroxyzine and
gabapentin) and 40 bup/nx protocol subjects (treated with 4-day scheduled bup/nx taper). Both groups received ancillary medications
and routine counseling. Primary outcomes were completion of medically supervised withdrawal and facilitation to further chemical
dependency treatment. Secondary outcomes included length of hospital stay, Clinical Opiate Withdrawal Scale (COWS) scores,
ancillary medication use, adverse eff ects and initiation of injectable extended release (ER) naltrexone treatment.
Results: Non-opioid protocol subjects were more likely to complete medically supervised withdrawal (94% vs. 80%, p=0.026) and
engage in further chemical dependency treatment (85% vs. 63%, p=0.006). Th e non-opioid protocol subjects had a lower incidence
of bradycardia (44% vs. 65%, p=0.035) and lower mean COWS scores on day 1 (3.3 vs. 4.8; p<0.001). A total of 27 (32%) subjects in
the non-opioid protocol group pursued transition to ER naltrexone and 24 of the 27 (89%) received the injection prior to hospital
discharge.
Conclusion: Th is retrospective chart review suggests potential effi cacy of a novel protocol, containing no opioids or controlled
substances, for medically supervised opioid withdrawal and transition to relapse prevention strategies, including injectable ER
naltrexone.