{"title":"口服美沙酮与舌下丁丙诺啡治疗急性阿片类药物戒断:一项三盲、双虚拟、随机对照试验","authors":"Anil Shekhawat , Atul Ambekar , Alok Agrawal , Ravindra Venkat Rao , Ashwani Kumar Mishra , Arpit Parmar , Tathagata Biswas","doi":"10.1016/j.drugalcdep.2025.112793","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Opioid use disorder (OUD) is a global problem with treatment involving an initial assisted withdrawal followed by maintenance phase. Methadone and buprenorphine are most commonly used agents for acute opioid withdrawal management (AOWM), but their comparative effectiveness remains uncertain. This study was aimed at comparing the efficacy and safety of oral methadone and sublingual buprenorphine for AOWM in in-patient setting.</div></div><div><h3>Methods</h3><div>A randomized double-dummy clinical trial was conducted with 79 patients (ages 18–60) admitted with OUD a tertiary-care center, New Delhi, India over three years (2017–2019). Participants received either oral methadone (20<!--> <!-->mg/day; n = 40) or sublingual buprenorphine (3.6<!--> <!-->mg/day; n = 39) in a fixed schedule allowing gradual tapering from day 4–10. The primary outcome was treatment completion rate, with secondary outcomes including withdrawal severity (COWS, SOWS scores), opioid craving (VAS), additional medication use, and side effects. The study was conducted after approval from the Institutional Ethics Committee (IEC).</div></div><div><h3>Results</h3><div>Both groups were comparable in terms of sociodemographic and baseline clinical parameters. Both groups had similar treatment completion rates (buprenorphine: 82 %, methadone: 82.5 %; <em>p</em> = 0.95). While both medications significantly reduced withdrawal symptoms and cravings over time, methadone showed greater reductions in withdrawal severity (COWS, SOWS scores; <em>p</em> = 0.01). Side effects were comparable between groups.</div></div><div><h3>Conclusion</h3><div>Methadone and buprenorphine demonstrated similar efficacy in treatment completion rates for acute opioid withdrawal. These findings suggest that methadone, alongside buprenorphine, can be an effective and safe option for acute opioid withdrawal management in inpatient settings.</div></div><div><h3>Trial Registration</h3><div>CTRI/2017/03/0079977</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"274 ","pages":"Article 112793"},"PeriodicalIF":3.6000,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Oral methadone versus sublingual buprenorphine for the treatment of acute opioid withdrawal: A triple-blind, double-dummy, randomized control trial\",\"authors\":\"Anil Shekhawat , Atul Ambekar , Alok Agrawal , Ravindra Venkat Rao , Ashwani Kumar Mishra , Arpit Parmar , Tathagata Biswas\",\"doi\":\"10.1016/j.drugalcdep.2025.112793\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Opioid use disorder (OUD) is a global problem with treatment involving an initial assisted withdrawal followed by maintenance phase. Methadone and buprenorphine are most commonly used agents for acute opioid withdrawal management (AOWM), but their comparative effectiveness remains uncertain. This study was aimed at comparing the efficacy and safety of oral methadone and sublingual buprenorphine for AOWM in in-patient setting.</div></div><div><h3>Methods</h3><div>A randomized double-dummy clinical trial was conducted with 79 patients (ages 18–60) admitted with OUD a tertiary-care center, New Delhi, India over three years (2017–2019). Participants received either oral methadone (20<!--> <!-->mg/day; n = 40) or sublingual buprenorphine (3.6<!--> <!-->mg/day; n = 39) in a fixed schedule allowing gradual tapering from day 4–10. The primary outcome was treatment completion rate, with secondary outcomes including withdrawal severity (COWS, SOWS scores), opioid craving (VAS), additional medication use, and side effects. The study was conducted after approval from the Institutional Ethics Committee (IEC).</div></div><div><h3>Results</h3><div>Both groups were comparable in terms of sociodemographic and baseline clinical parameters. Both groups had similar treatment completion rates (buprenorphine: 82 %, methadone: 82.5 %; <em>p</em> = 0.95). While both medications significantly reduced withdrawal symptoms and cravings over time, methadone showed greater reductions in withdrawal severity (COWS, SOWS scores; <em>p</em> = 0.01). Side effects were comparable between groups.</div></div><div><h3>Conclusion</h3><div>Methadone and buprenorphine demonstrated similar efficacy in treatment completion rates for acute opioid withdrawal. These findings suggest that methadone, alongside buprenorphine, can be an effective and safe option for acute opioid withdrawal management in inpatient settings.</div></div><div><h3>Trial Registration</h3><div>CTRI/2017/03/0079977</div></div>\",\"PeriodicalId\":11322,\"journal\":{\"name\":\"Drug and alcohol dependence\",\"volume\":\"274 \",\"pages\":\"Article 112793\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-07-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Drug and alcohol dependence\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0376871625002467\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PSYCHIATRY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Drug and alcohol dependence","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0376871625002467","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}
Oral methadone versus sublingual buprenorphine for the treatment of acute opioid withdrawal: A triple-blind, double-dummy, randomized control trial
Background
Opioid use disorder (OUD) is a global problem with treatment involving an initial assisted withdrawal followed by maintenance phase. Methadone and buprenorphine are most commonly used agents for acute opioid withdrawal management (AOWM), but their comparative effectiveness remains uncertain. This study was aimed at comparing the efficacy and safety of oral methadone and sublingual buprenorphine for AOWM in in-patient setting.
Methods
A randomized double-dummy clinical trial was conducted with 79 patients (ages 18–60) admitted with OUD a tertiary-care center, New Delhi, India over three years (2017–2019). Participants received either oral methadone (20 mg/day; n = 40) or sublingual buprenorphine (3.6 mg/day; n = 39) in a fixed schedule allowing gradual tapering from day 4–10. The primary outcome was treatment completion rate, with secondary outcomes including withdrawal severity (COWS, SOWS scores), opioid craving (VAS), additional medication use, and side effects. The study was conducted after approval from the Institutional Ethics Committee (IEC).
Results
Both groups were comparable in terms of sociodemographic and baseline clinical parameters. Both groups had similar treatment completion rates (buprenorphine: 82 %, methadone: 82.5 %; p = 0.95). While both medications significantly reduced withdrawal symptoms and cravings over time, methadone showed greater reductions in withdrawal severity (COWS, SOWS scores; p = 0.01). Side effects were comparable between groups.
Conclusion
Methadone and buprenorphine demonstrated similar efficacy in treatment completion rates for acute opioid withdrawal. These findings suggest that methadone, alongside buprenorphine, can be an effective and safe option for acute opioid withdrawal management in inpatient settings.
期刊介绍:
Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.