Gregory Rudolf
American Board of Addiction Medicine, USA
Title: Non-opioid protocol for opioid detoxifi cation and/or transition to antagonist treatment
Biography
Biography: Gregory Rudolf
Abstract
Introduction: Th e clinical eff ectiveness of a novel non-opioid and benzodiazepine-free protocol was compared to a
buprenorphine/naltrexone taper for opioid detoxifi cation and transition to subsequent relapse prevention strategies, including
initiation of extended release (ER) naltrexone treatment.
Methods: Retrospective chart review of DSM IV diagnosed opioid-dependent patients admitted for inpatient detoxifi cation
examined diff erences between 84 non-opioid protocol (treated with scheduled 4-day tizanidine, hydroxyzine and gabapentin)
and 40 bup/nx protocol (treated with scheduled 4-day bup/nx taper) subjects. Both groups received ancillary medications and
routine counseling. Primary outcomes measured completion of detoxifi cation and facilitation to further chemical dependency
treatment. Secondary outcomes included length of stay (LOS), adverse eff ects, Clinical Opiate Withdrawal Scale (COWS)
scores, ancillary medication use and initiation of injectable ER naltrexone treatment.
Results: Non-opioid protocol subjects had greater completion of detoxifi cation (94% vs. 80%; p=0.029) and facilitation to
further chemical dependency treatment (85% vs. 63%; p=0.004). Th e non-opioid protocol was superior to the bup/nx protocol
in lower incidence of bradycardia (44% vs. 65%; p=0.040) and lower mean COWS scores on day 1 (3.3 vs. 4.8; p<0.001).
No signifi cant diff erence was found in mean COWS scores on day 2 (3.4 vs. 3.2), day 3 (2.8 vs. 2.1) and day 4 (2.4 vs.1.9);
asymptomatic (26% vs. 35%) and symptomatic (8/3% vs. 10%) hypotension; LOS (3.6 vs. 3.4) and ancillary medication use
(11.6 vs. 11.8 doses). A total of 27 (32%) of patients in the non-opioid protocol arm pursued transition to ER naltrexone and
24 (89%) of them received the injection prior to hospital discharge.
Conclusion: Th is retrospective, non-randomized, case review study demonstrates a novel, eff ective non-opioid detoxifi cation
protocol using scheduled tizanidine, hydroxyzine and gabapentin for management of opioid withdrawal during the phase
between cessation of opioids and initiation of relapse prevention strategies, including transition to injectable ER naltrexone