Dual Diagnosis

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.