A meta-analysis of Chinese herbal medicine in treatment of managed withdrawal from heroin

Abstract

Chinese herbal medicine has shown promise for heroin detoxification. This review extends a prior meta-analysis of Chinese herbal medicine for heroin detoxification, with particular attention to the time course of symptoms. Both English and Chinese databases were searched for randomized trials comparing Chinese herbal medicine to either alpha2-adrenergic agonists or opioid agonists for heroin detoxification. The methodological quality of each study was assessed with Jadad's scale (1-2 = low; 3-5 = high). Meta-analysis was performed with fixed- or random-effect models in RevMan software; outcome measures assessed were withdrawal-symptoms score, anxiety, and adverse effects of treatment. Twenty-one studies (2,949 participants) were included. For withdrawal-symptoms score relieving during the 10-day observation, Chinese herbal medicine was superior to alpha2-adrenergic agonists in relieving opioid-withdrawal symptoms during 4-10 days (except D8) and no difference was found within the first 3 days. Compared with opioid agonists, Chinese herbal medicine was inferior during the first 3 days, but the difference became non-significant during days 4-9. Chinese herbal medicine has better effect on anxiety relieving at late stage of intervention than alpha2-adrenergic agonists, and no difference with opioid agonists. The incidence of some adverse effects (fatigue, dizziness) was significantly lower for Chinese herbal medicine than for alpha2-adrenergic agonists (sufficient data for comparison with opioid agonists were not available). Findings were robust to file-drawer effects. Our meta-analysis suggests that Chinese herbal medicine is an effective and safety treatment for heroin detoxification. And more work is needed to determine the specific effects of specific forms of Chinese herbal medicine.

Fig. 1

Efficacy of Chinese herbal medicine (CHM) compared with α2-adrenergic agonists (A), and opioid agonists (B) in alleviating opioid-withdrawal symptoms. Summary estimates of the weighted mean differences (WMDs) and their 95% CIs are given day by day. D0 indicates pretreatment baseline. D0, D5, D6, D9, D10 in (A) and D0, D1, D2 in (B) were analyzed in fixed-effects models. The other time points were analyzed in random-effects models. N_R indicates the fail-safe number, i.e. the number of unpublished negative studies that would be required to overturn each significant finding at an alpha level of 0.05

Fig. 2

Efficacy of CHM compared with α2-adrenergic agonists (A), and opioid agonists (B) in relieving anxiety. Summary estimates of the weighted mean differences (WMDs) and their 95% CIs are given at three time points. “Beginning” and “End” in (A) and “Beginning,” “middle,” and “End” in (B) were analyzed in fixed-effects models. The other time points were analyzed in random-effects models. N_R indicates the fail-safe number, i.e. the number of unpublished negative studies that would be required to overturn each significant finding at an alpha level of 0.05

Fig. 3

Safety of CHM compared with α2-adrenergic agonists. Summary estimates of the relative risks (RRs) and their 95% CIs are shown for each of the five most commonly reported adverse effects. All RRs were analyzed in random-effects models. N_R indicates the fail-safe number, i.e. the number of unpublished negative studies that would be required to overturn each significant finding at an alpha level of 0.05