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Meta-Analysis
. 2013 Feb 28;2013(2):CD003409.
doi: 10.1002/14651858.CD003409.pub4.

Methadone at tapered doses for the management of opioid withdrawal

Laura Amato  1 , Marina Davoli, Silvia Minozzi, Eliana Ferroni, Robert Ali, Marica Ferri
Affiliations
Meta-Analysis

Methadone at tapered doses for the management of opioid withdrawal

Laura Amato et al. Cochrane Database Syst Rev. .

Abstract

Background: The evidence of tapered methadone's efficacy in managing opioid withdrawal has been systematically evaluated in the previous version of this review that needs to be updated

Objectives: To evaluate the effectiveness of tapered methadone compared with other detoxification treatments and placebo in managing opioid withdrawal on completion of detoxification and relapse rate.

Search methods: We searched: Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 4), PubMed (January 1966 to May 2012), EMBASE (January 1988 to May 2012), CINAHL (2003- December 2007), PsycINFO (January 1985 to December 2004), reference lists of articles.

Selection criteria: All randomised controlled trials that focused on the use of tapered methadone versus all other pharmacological detoxification treatments or placebo for the treatment of opiate withdrawal.

Data collection and analysis: Two review authors assessed the included studies. Any doubts about how to rate the studies were resolved by discussion with a third review author. Study quality was assessed according to the criteria indicated in the Cochrane Handbook for Systematic Reviews of Interventions.

Main results: Twenty-three trials involving 2467 people were included. Comparing methadone versus any other pharmacological treatment, we observed no clinical difference between the two treatments in terms of completion of treatment, 16 studies 1381 participants, risk ratio (RR) 1.08 (95% confidence interval (CI) 0.97 to 1.21); number of participants abstinent at follow-up, three studies, 386 participants RR 0.98 (95% CI 0.70 to 1.37); degree of discomfort for withdrawal symptoms and adverse events, although it was impossible to pool data for the last two outcomes. These results were confirmed also when we considered the single comparisons: methadone with: adrenergic agonists (11 studies), other opioid agonists (eight studies), anxiolytic (two studies), paiduyangsheng (one study). Comparing methadone with placebo (two studies) more severe withdrawal and more drop-outs were found in the placebo group. The results indicate that the medications used in the included studies are similar in terms of overall effectiveness, although symptoms experienced by participants differed according to the medication used and the program adopted.

Authors' conclusions: Data from literature are hardly comparable; programs vary widely with regard to the assessment of outcome measures, impairing the application of meta-analysis. The studies included in this review confirm that slow tapering with temporary substitution of long- acting opioids, can reduce withdrawal severity. Nevertheless, the majority of patients relapsed to heroin use.

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Conflict of interest statement

None known.

Figures

1
1
Flow chart of studies
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
4
4
Forest plot of comparison: 1 Tapered methadone versus any other treatment, outcome: 1.1 Completion of treatment.
5
5
Forest plot of comparison: 1 Tapered methadone versus any other treatment, outcome: 1.2 Number of participants abstinent at follow‐up.
1.1
1.1. Analysis
Comparison 1 Tapered methadone versus any other treatment, Outcome 1 Completion of treatment.
1.2
1.2. Analysis
Comparison 1 Tapered methadone versus any other treatment, Outcome 2 Number of participants abstinent at follow‐up.
2.1
2.1. Analysis
Comparison 2 Tapered methadone versus adrenergic agonists, Outcome 1 Completion of treatment.
3.1
3.1. Analysis
Comparison 3 Tapered methadone versus other opioid agonists, Outcome 1 Completion of treatment methadone versus any other opioid agonist.
3.2
3.2. Analysis
Comparison 3 Tapered methadone versus other opioid agonists, Outcome 2 Completion of treatment methadone versus buprenorphine.
4.1
4.1. Analysis
Comparison 4 Tapered methadone versus anxiolytic, Outcome 1 Completion of treatment.
5.1
5.1. Analysis
Comparison 5 Tapered methadone versus placebo, Outcome 1 Completion of treatment.
See this image and copyright information in PMC

Update of

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