Document Detail

Tramadol versus buprenorphine for the management of acute heroin withdrawal: a retrospective matched cohort controlled study.
MedLine Citation:
PMID:  16595358     Owner:  NLM     Status:  MEDLINE    
Many medications have been used over the past thirty years for the treatment of opioid withdrawal, including propoxyphene, methadone, clonidine, parenteral buprenorphine, and, more recently, sublingual buprenorphine. Each has been found to have clinical strengths and limitations. Tramadol is a centrally acting synthetic analgesic with opiate activity primarily due to the binding of a metabolite to the micro receptor. Despite this micro receptor activity, tramadol appears to have low abuse potential and is a non-scheduled analgesic. The pharmacologic profile of tramadol makes it a candidate for opiate withdrawal treatment. A chart review was undertaken to retrospectively compare treatment outcomes of heroin-dependent patients when detoxified with parenteral buprenorphine (1996-1997) versus tramadol (1999-2000). Inclusion criteria for this study were heroin as drug of choice, current opioid physical dependence (ie, withdrawal symptoms), no current abuse of oral opioid analgesics, and no alcohol or benzodiazepine withdrawal symptoms. Patient cases that met inclusion criteria were group-matched between buprenorphine and tramadol on the basis of age, sex, and amount of heroin used (bags/day). Charts were audited for patient demographics, daily heroin use at admission, withdrawal symptoms, and discharge status. In total, 129 patient charts were reviewed, and 115 met all inclusion criteria and were group-matched (45 patients in the buprenorphine group, seventy in the tramadol group). There were no differences in demographics between the two groups of patients. Fifty-six percent of the buprenorphine group and 71% of the tramadol group completed detoxification; tramadol-treated patients had significantly higher average withdrawal symptoms when compared to the buprenorphine group and a greater reduction in withdrawal symptoms over time. Finally, the number of side effects was small and did not differ between the groups. The results of this study are consistent with previous pilot reports that indicated few clinical differences between parenteral buprenorphine and oral tramadol protocols when used in the management of acute heroin withdrawal. As a consequence, tramadol shows some promise as an opioid withdrawal management medication.
Melinda Threlkeld; Theodore V Parran; Christopher A Adelman; Scott F Grey; Jaehak Yu
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal on addictions / American Academy of Psychiatrists in Alcoholism and Addictions     Volume:  15     ISSN:  1055-0496     ISO Abbreviation:  Am J Addict     Publication Date:    2006 Mar-Apr
Date Detail:
Created Date:  2006-04-05     Completed Date:  2007-04-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9208821     Medline TA:  Am J Addict     Country:  United States    
Other Details:
Languages:  eng     Pagination:  186-91     Citation Subset:  IM    
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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MeSH Terms
Buprenorphine / therapeutic use*
Dose-Response Relationship, Drug
Drug Administration Schedule
Heroin / adverse effects*
Heroin Dependence / rehabilitation*
Middle Aged
Narcotics / therapeutic use*
Neurologic Examination / drug effects
Patient Dropouts / statistics & numerical data
Retrospective Studies
Substance Withdrawal Syndrome / diagnosis,  rehabilitation*
Tramadol / therapeutic use*
Treatment Outcome
Reg. No./Substance:
0/Narcotics; 27203-92-5/Tramadol; 52485-79-7/Buprenorphine; 561-27-3/Heroin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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