Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Feb 18;2(2):CD012254.
doi: 10.1002/14651858.CD012254.pub2.

Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders

Tara Carney  1 , Marie Claire Van Hout  2 , Ian Norman  3 , Siphokazi Dada  4 , Nandi Siegfried  4 , Charles Dh Parry  1   5
Affiliations
Meta-Analysis

Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders

Tara Carney et al. Cochrane Database Syst Rev. .

Abstract

Background: Medical treatment and detoxification from opiate disorders includes oral administration of opioid agonists. Dihydrocodeine (DHC) substitution treatment is typically low threshold and therefore has the capacity to reach wider groups of opiate users. Decisions to prescribe DHC to patients with less severe opiate disorders centre on its perceived safety, reduced toxicity, shorter half-life and more rapid onset of action, and potential retention of patients. This review set out to investigate the effects of DHC in comparison to other pharmaceutical opioids and placebos in the detoxification and substitution of individuals with opiate use disorders.

Objectives: To investigate the effectiveness of DHC in reducing illicit opiate use and other health-related outcomes among adults compared to other drugs or placebos used for detoxification or substitution therapy.

Search methods: In February 2019 we searched Cochrane Drugs and Alcohol's Specialised Register, CENTRAL, PubMed, Embase and Web of Science. We also searched for ongoing and unpublished studies via ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and Trialsjournal.com. All searches included non-English language literature. We handsearched references of topic-related systematic reviews and the included studies.

Selection criteria: We included randomised controlled trials that evaluated the effect of DHC for detoxification and maintenance substitution therapy for adolescent (aged 15 years and older) and adult illicit opiate users. The primary outcomes were abstinence from illicit opiate use following detoxification or maintenance therapy measured by self-report or urinalysis. The secondary outcomes were treatment retention and other health and behaviour outcomes.

Data collection and analysis: We followed the standard methodological procedures that are outlined by Cochrane. This includes the GRADE approach to appraise the quality of evidence.

Main results: We included three trials (in five articles) with 385 opiate-using participants that measured outcomes at different follow-up periods in this review. Two studies with 150 individuals compared DHC with buprenorphine for detoxification, and one study with 235 participants compared DHC to methadone for maintenance substitution therapy. We downgraded the quality of evidence mainly due to risk of bias and imprecision. For the two studies that compared DHC to buprenorphine, we found low-quality evidence of no significant difference between DHC and buprenorphine for detoxification at six-month follow-up (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.25 to 1.39; P = 0.23) in the meta-analysis for the primary outcome of abstinence from illicit opiates. Similarly, low-quality evidence indicated no difference for treatment retention (RR 1.29, 95% CI 0.99 to 1.68; P = 0.06). In the single trial that compared DHC to methadone for maintenance substitution therapy, the evidence was also of low quality, and there may be no difference in effects between DHC and methadone for reported abstinence from illicit opiates (mean difference (MD) -0.01, 95% CI -0.31 to 0.29). For treatment retention at six months' follow-up in this single trial, the RR calculated with an intention-to-treat analysis also indicated that there may be no difference between DHC and methadone (RR 1.04, 95% CI 0.94 to 1.16). The studies that compared DHC to buprenorphine reported no serious adverse events, while the DHC versus methadone study reported one death due to methadone overdose.

Authors' conclusions: We found low-quality evidence that DHC may be no more effective than other commonly used pharmacological interventions in reducing illicit opiate use. It is therefore premature to make any conclusive statements about the effectiveness of DHC, and it is suggested that further high-quality studies are conducted, especially in low- to middle-income countries.

PubMed Disclaimer

Conflict of interest statement

Tara Carney: none known

Marie Claire Van Hout: none known

Ian Norman: none known

Siphokazi Dada: none known

Nandi Siegfried: none known

Charles DH Parry: none known

Figures

1
1
Study flow diagram
2
2
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study
3
3
'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012254

Similar articles

See all similar articles

Cited by

References

References to studies included in this review

Robertson 2006 {published data only}
    1. Robertson RJ, Raab GM, Bruce M, McKenzie JS, Storkey HR, Salter A. Addressing the efficacy of dihydrocodeine versus methadone as an alternative maintenance treatment for opiate dependence: a randomized controlled trial. Addiction 2006;101(12):1752‐9. - PubMed
Sheard 2009 {published data only}
    1. Sheard L, Adams CE, Wright NM, El‐Sayeh H, Dalton R, Tompkins CN. The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS) prisons project pilot study: protocol for a randomised controlled trial comparing dihydrocodeine and buprenorphine for opiate detoxification. Trials 2007;8(1):1‐5. - PMC - PubMed
    1. Sheard L, Wright NM, El‐Sayeh HG, Adams CA, Li R, Tompkins CN. The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS) prisons project: a randomised controlled trial comparing dihydrocodeine and buprenorphine for opiate detoxification. Substance Abuse Treatment, Prevention, and Policy 2009;4(1):1‐11. [DOI: 10.1186/1747-597X-4-1] - DOI - PMC - PubMed
Wright 2007 {published data only}
    1. Oldham NS, Wright NM, Adams CE, Sheard L, Tompkins CN. The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS) project: an open‐label pragmatic randomised control trial comparing the efficacy of differing therapeutic agents for primary care detoxification from either street heroin or methadone. BMC Family Practice 2004; Vol. 5, issue 9. [DOI: 10.1186/1471-2296-5-9] - DOI - PMC - PubMed
    1. Wright NM, Sheard L, Tompkins CN, Adams CE, Allgar VL, Oldham NS. Buprenorphine versus dihydrocodeine for opiate detoxification in primary care: a randomised controlled trial. BMC Family Practice 2007; Vol. 8, issue 3. [DOI: 10.1186/1471-2296-8-3] - DOI - PMC - PubMed

References to studies excluded from this review

Backmund 2001 {published data only}
    1. Backmund M, Meyer K, Eichenlaub D, Schütz CG. Predictors for completing an inpatient detoxification program among intravenous heroin users, methadone substituted and codeine substituted patients. Drug and Alcohol Dependence 2001;64(2):173‐80. - PubMed
Banbery 2000 {published data only}
    1. Banbery J, Wolff K, Raistrick D. A useful tool in the detoxification of methadone‐maintained patients. Journal of Substance Abuse Treatment 1999;19(3):301‐5. - PubMed
Bell 2007 {published data only}
    1. Bell J, Zador D. Dihydrocodeine as effective as methadone for maintenance of treatment for opiate dependence?. Evidence‐based Mental Health Vol. 10, issue 3:88. - PubMed
Carnwath 2002 {published data only}
    1. Carnwath T, Marrill J. Dose equivalents in opioid substitution treatment. International Journal of Drug Policy 2002;13(6):445‐7.
Day 2003 {published data only}
    1. Day E, Fisher K, Watson J, Al‐Gommer O, McCormick T. The role of detoxification using methadone reduction in a drug treatment service. Journal of Substance Abuse 2003;8(4):252‐9.
Friessem 1991 {published data only}
    1. Friessem DH, Täschner KL. Codeine and dihydrocodeine as substitute and alternative drugs. Fortschritte der Neurologie‐Psychiatrie 1991;59(5):164‐9. - PubMed
Hall 2007 {published data only}
    1. Hall WD, Mattick PR. Clinical update: codeine maintenance in opioid dependence. Lancet 2007;370:550‐2. [DOI: 10.1016/S0140-6736(07)61273-2] - DOI - PubMed
Krausz 1995 {published data only}
    1. Krausz M, Degkwitz P, Wernecke A, Verthein U, Chorzelski G, Behrendt K. Drug substitution treatment of heroin dependent patients with codeine preparations‐treatment effects from the viewpoint of the physicians and patients. Psychiatrische Praxis 1995;22(5):179‐85. - PubMed
Krausz 1998 {published data only}
    1. Krausz M, Verthein U, Degkwitz P, Haasen C, Raschke P. Maintenance treatment of opiate addicts in Germany with medications containing codeine: results of a follow‐up study. Addiction 1998;93(8):1161‐7. - PubMed
Pearson 2000 {published data only}
    1. Pearson R, Robertson G, Gibb R. The identification and treatment of opiate users in police custody. Medicine, Science and the Law 2000;40(4):305‐12. - PubMed
Seymour 2001 {published data only}
    1. Seymour A, Black M, Oliver JS, Jay J. Dihydrocodeine — drug of use or misuse?. British Journal of General Practice 2001;51(446):404‐5. - PMC - PubMed
Swadi 1990 {published data only}
    1. Swadi H, Wells B, Power R. Misuse of dihydrocodeine tartrate (DF 118) among opiate addicts. BMJ 1990;300(6735):1313. - PMC - PubMed
Ulmer 2007 {published data only}
    1. Ulmer A, Mueller M, Frietsch B. Dihydrocodeine treatment of alcohol addicts with previous opiate addiction‐case reports. Heroin Addiction and Related Clinical Problems 2007;9(2):55‐64.
Ulmer 2012 {published data only}
    1. Ulmer A, Mueller M, Frietsch B. Dihydrocodeine/agonists for alcohol dependents. Frontiers in Psychiatry 2012;3:1‐7. [DOI: 10.3389/fpsyt.2012.00021] - DOI - PMC - PubMed
Zamparutti 2010 {published data only}
    1. Zamparutti G, Schifano F, Corkery JM, Oyefeso A, Ghodse AH. Deaths of opiate/opioid misusers involving dihydrocodeine, UK, 1997–2007. British Journal of Clinical Pharmacology 2010;72(2):330‐7. - PMC - PubMed

Additional references

Amato 2005
    1. Amato L, Davolia M, Peruccia CA, Ferria M, Faggiano F, Mattick RP. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. Journal of Substance Abuse Treatment 2005;28(4):321‐9. [DOI: ] - PubMed
Amato 2011
    1. Amato L, Minozzi S, Davoli M, Vecchi S. Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Cochrane Database of Systematic Reviews 2011, Issue 10. [DOI: 10.1002/14651858.CD004147.pub4] - DOI - PubMed
Amato 2013
    1. Amato L, Davoli M, Minozzi S, Ferroni E, Ali R, Ferri M. Methadone at tapered doses for the management of opioid withdrawal. Cochrane Database of Systematic Reviews 2013, Issue 2. [DOI: 10.1002/14651858.CD003409.pub4] - DOI - PMC - PubMed
APA 2013
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Washington, DC: American Psychiatric Association, 2013.
Arora 2013
    1. Arora A, Williams K. Problem based review: the patient taking methadone. Acute Medicine 2013;12(1):51‐4. - PubMed
Auriacombe 2004
    1. Auriacombe M, Fatséas M, Dubernet J, Daulouède JP, Tignol J. French field experience with buprenorphine. American Journal on Addictions 2004;13:S17‐S28. [DOI: ] - PubMed
Bao 2009
    1. Bao Y, Liu Z, Epstein DH, Du C, Shi J, Lu L. A meta‐analysis of retention in methadone maintenance by dose and dosing strategy. American Journal of Drug and Alcohol Abuse 2009;35(1):28‐33. [DOI: 10.1080/00952990802342899] - DOI - PMC - PubMed
Connock 2007
    1. Connock M, Juarez Garcia A, Jowett S, Frew E, Liu Z, Taylor RJ, et al. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technology Assessment 2007;11(9):1‐171. [DOI: 10.3310/hta11090] - DOI - PubMed
Cook 2018
    1. Cook C, Davies C. The lost decade: neglect for harm reduction funding and the health crisis among people who use drugs. London: Harm Reduction International, 2018.
Darke 2002
    1. Darke S, Ross J. Suicide among heroin users: rates, risk factors and methods. Addiction 2002;97(11):1384‐94. [DOI: 10.1046/j.1360-0443.2002.00214.x] - DOI - PubMed
Darke 2012
    1. Darke S, Campbell G, Popple G. Self‐harm and attempted suicide among therapeutic community admissions. Drug and Alcohol Review 2012;31(4):523‐8. [DOI: 10.1111/j.1465-3362.2011.00344.x] - DOI - PubMed
Davoli 2015
    1. Davoli M, Amato L, Clark N, Farrell M, Hickman M, Hill S, et al. The role of Cochrane Reviews in informing international guidelines: a case study of using the Grading of Recommendations, Assessment, Development and Evaluation system to develop World Health Organization guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Addiction 2015;110(6):891‐8. [DOI: 10.1111/add.12788.] - DOI - PubMed
Deeks 2017
    1. Deeks JJ, Higgins JP, Altman DG (editors) on behalf ofthe Cochrane Statistical Methods Group. Chapter 9: Analysing data and undertaking meta‐analyses. In: Higgins JPT, Churchill R, Chandler J, Cumpston MS (editors), Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017), Cochrane, 2017. Available from www.training.cochrane.org/handbook.
Degenhardt 2011
    1. Degenhardt L, Bucello C, Mathers B, Briegleb C, Ali H, Hickman M, et al. Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta‐analysis of cohort studies. Addiction 2011;106(1):32‐51. [DOI: 10.1111/j.1360-0443.2010.03140.x] - DOI - PubMed
Degenhardt 2014
    1. Degenhardt L, Charlson F, Mathers B, Hall WD, Flaxman AD, Johns N, et al. The global epidemiology and burden of opioid dependence: results from the global burden of disease 2010 study. Addiction 2014;109(9):1320‐33. [DOI: 10.1111/add.12551] - DOI - PubMed
Ferri 2011
    1. Ferri M, Davoli M, Perucci CA. Heroin maintenance for chronic heroin‐dependent individuals. Cochrane Database of Systematic Reviews 2011, Issue 12. [DOI: 10.1002/14651858.CD003410.pub4] - DOI - PMC - PubMed
Ferri 2013
    1. Ferri M, Minozzi AB, Amato L. Slow‐release oral morphine as maintenance therapy for opioid dependence. Cochrane Database of Systematic Reviews 2013, Issue 6. [DOI: 10.1002/14651858.CD009879.pub2] - DOI - PMC - PubMed
Finnegan 1975
    1. Finnegan L, Connaughton J, Kron R, Emich J. Neonatal abstinence syndrome: assessment and management. Journal of Addictive Diseases 1975;2(1‐2):141‐58. [DOI: 10.1186/1940-0640-9-19] - DOI - PubMed
Gomes 2018
    1. Gomes T, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. The burden of opioid‐related mortality in the United States. JAMA Network Open 2018;1(2):e180217. - PMC - PubMed
Gowing 2011
    1. Gowing L, Farrell MF, Bornemann R, Sullivan LE, Ali R. Oral substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database of Systematic Reviews 2011, Issue 8. [DOI: 10.1002/14651858.CD004145.pub4] - DOI - PubMed
Gowing 2016
    1. Gowing L, Farrell MF, Ali R, White JM. Alpha2‐adrenergic agonists for the management of opioid withdrawal. Cochrane Database of Systematic Reviews 2016, Issue 5. [DOI: 10.1002/14651858.CD002024.pub5] - DOI - PubMed
Gowing 2017a
    1. Gowing L, Ali R, White JM. Buprenorphine for managing opioid withdrawal. Cochrane Database of Systematic Reviews 2017, Issue 2. [DOI: 10.1002/14651858.CD002025.pub5] - DOI - PMC - PubMed
Gowing 2017b
    1. Gowing L, Ali R, White JM. Opioid antagonists with minimal sedation for opioid withdrawal. Cochrane Database of Systematic Reviews 2017, Issue 5. [DOI: 10.1002/14651858.CD002021.pub4] - DOI - PMC - PubMed
GRADE 2004
    1. GRADE working group. Grading quality of evidence and strength of recommendations. BMJ 2004;328(7454):1490‐4. [DOI: 10.1136/bmj.328.7454.1490] - DOI - PMC - PubMed
Guyatt 2008
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7560):924‐6. [DOI: 10.1136/bmj.39489.470347.AD] - DOI - PMC - PubMed
Guyatt 2011
    1. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines 1. Introduction‐GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2011;64(4):383–94. [DOI: ] - PubMed
Hellard 2009
    1. Hellard M, Sacks‐Davis R, Gold J. Hepatitis C treatment for injection drug users: a review of the available evidence. Clinical Infectious Diseases 2009;49(4):561‐73. [DOI: 10.1086/600304] - DOI - PubMed
Hickman 2007
    1. Hickman M, Carrivick S, Paterson S, Hunt N, Zador D, Cusick L, Henry J. London audit of drug‐related overdose deaths: characteristics and typology, and implications for prevention and monitoring. Addiction 2007;102:317–23. - PubMed
Higgins 2017
    1. Higgins JP, Altman DG, Sterne JA (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Churchill R, Chandler J, Cumpston MS (editors), Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017), Cochrane, 2017. Available from www.training.cochrane.org/handbook.
Jansson 2009
    1. Jansson LM, Velez, MD, Harrow C. The opioid exposed newborn: assessment and pharmacologic management. Journal of Opioid Management 2009;5(1):47‐55. - PMC - PubMed
Kermode 2011
    1. Kermode M, Crofts N, Suresh Kumar M, Dorabjee J. Opioid substitution therapy in resource‐poor settings. Bulletin of the World Health Organization 2011;89:243. [DOI: 10.2471/BLT.11.086850] - DOI - PMC - PubMed
Klepstad 2005
    1. Klepstad P, Kaasa S, Cherny N, Hanks G, Conno FR. Pain and pain treatments in European palliative care units. A cross sectional survey from the European Association for Palliative Care Research Network. Palliative Medicine 2005;19(6):477–84. [DOI: 10.1191/0269216305pm1054oa] - DOI - PubMed
Lawrinson 2008
    1. Lawrinson P, Ali R, Buavirat A, Chiamwongpaet S, Dvoryak S, Habrat B, et al. Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS. Addiction 2008;103:1484‐92. [DOI: 10.1111/j.1360-0443.2008.02249.x.] - DOI - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.handbook.cochrane.org.
Leppert 2010
    1. Leppert W. Dihydrocodeine as an opioid analgesic for the treatment of moderate to severe chronic pain. Current Drug Metabolism 2010;11(6):494‐506. [DOI: 10.2174/138920010791636211] - DOI - PubMed
Luty 2004
    1. Luty J. Treatment preferences of opiate‐dependent patients. Psychiatric Bulletin 2004;28(2):47‐50. [DOI: 10.1192/pb.28.2.47] - DOI
Maas 2013
    1. Maas J, Barton G, Maskrey V, Pinto H, Holland R. Economic evaluation: a comparison of methadone versus buprenorphine for opiate substitution treatment. Drug and Alcohol Dependence 2013;133(2):494‐501. [DOI: 10.1016/j.drugalcdep.2013.07.018] - DOI - PubMed
MacLeod 1998
    1. MacLeod J, Whittaker A, Robertson R. Changes in opiate treatment during attendance at a community drug service – findings from a clinical audit. Drug and Alcohol Review 1998;17(1):19‐25. [DOI: 10.1080/09595239800187561] - DOI - PubMed
Malek 2012
    1. Malek A. Effects of prenatal opiates exposure on human pregnancy and breastfeeding. Pharmaceutica Analytica Acta 2012;3(9):1000192. [DOI: 10.4172/2153%26#8208;2435.1000192] - DOI
Mathers 2010
    1. Mathers BM, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick RP, et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet 2010;375(9719):1014–28. [DOI: ] - PubMed
Mattick 2009
    1. Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD002209.pub2] - DOI - PMC - PubMed
Mattick 2014
    1. Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews 2014, Issue 2. [DOI: 10.1002/14651858.CD002207.pub4] - DOI
Minozzi 2013
    1. Minozzi S, Amato L, Bellisario C, Ferrri M, Davoli M. Maintenance agonist treatments for opiate‐dependent pregnant women. Cochrane Database of Systematic Reviews 2013, Issue 12. [DOI: 10.1002/14651858.CD006318.pub3] - DOI - PubMed
Minozzi 2014
    1. Minozzi S, Amato L, Bellisario C, Davoli M. Maintenance treatments for opiate‐dependent adolescents. Cochrane Database of Systematic Reviews 2014, Issue 6. [DOI: 10.1002/14651858.CD007210.pub3] - DOI - PMC - PubMed
Mitchell 2003
    1. Mitchell TB, White JM, Somogyi AA, Bochner F. Comparative pharmacodynamics and pharmacokinetics of methadone and slow release oral morphine for maintenance treatment of opioid dependence. Drug and Alcohol Dependence 2003;72(1):85–94. [DOI: ] - PubMed
Moher 2009
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA Statement. PLoS Medicine 6;7:e1000097. [DOI: 10.1371/journal.pmed1000097] - DOI - PMC - PubMed
Moore 2000
    1. Moore RA, Edwards J, Derry S, McQuay HJ. Single dose oral dihydrocodeine for acute postoperative pain. Cochrane Database of Systematic Reviews 2000, Issue 2. [DOI: 10.1002/14651858.CD002760] - DOI - PMC - PubMed
NICE 2007
    1. National Institute for Health and Care Excellence. Drug misuse – opioid detoxification: NICE clinical guidelines. www.nice.org.uk/guidance/cg52/evidence/drug‐misuse‐opioid‐detoxification... October 2015 (date accessed); Vol. 52.
OHRP 2007
    1. Office for Human Research Protections. Guidance on reviewing and reporting unanticipated problems involving risks to subjects or others and adverse events. www.hhs.gov/ohrp/regulations‐and‐policy/guidance/reviewing‐unanticipated... November 2015 (date accessed). [http://www.hhs.gov/ohrp/policy/advevntguid.html]
Oldham 2004
    1. Oldham N, Wright N, Adams C, Sheard L, Tompkins CN. The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS) Project: an open label pragmatic randomised control trial comparing the efficacy of differing therapeutic agents for primary care detoxification from either street heroin or methadone. BMC Family Practice 2004;5:1‐7. [DOI: 10.1186/1471-2296-5-9] - DOI - PMC - PubMed
Patrick 2012
    1. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000‐2009. JAMA 2012;307(18):1934‐40. [DOI: 10.1001/jama.2012.3951] - DOI - PubMed
Reith 2005
    1. Reith D, Fountain J, Tilyard M. Opioid poisoning deaths in New Zealand (2001–2002). New Zealand Medical Journal 2005;118(1209):U1293. - PubMed
Review Manager 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Riksheim 2014
    1. Riksheim M, Gossop M, Clausen T. From methadone to buprenorphine: changes during a 10 year period within a national opioid maintenance treatment programme. Journal of Substance Abuse Treatment 2014;46(3):291–4. [DOI: 10.1016/j.jsat.2013.10.006] - DOI - PubMed
Robertson 1990
    1. Robertson R, Witcomb J, Roberts J, Egan J. Misuse of dihydrocodeine tartrate (DF 118) among opiate addicts. BMJ 1990;301:119. [DOI: ] - PMC - PubMed
Sees 2000
    1. Sees KL, Delucchi KL, Masson C, Rosen A, Clark HW, Robillard H, et al. Methadone maintenance vs 180‐day psychosocially enriched detoxification for treatment of opioid dependence: a randomized controlled trial. JAMA 2000;283(10):1303‐10. [DOI: 10.1001/jama.283.10.1303] - DOI - PubMed
Seivewright 2000
    1. Seivewright N. Community Treatment of Drug Misuse: More than Methadone. Cambridge: Cambridge University Press, 2000:243.
Soyka 2015
    1. Soyka M. New developments in the management of opioid dependence: focus on sublingual buprenorphine‐naloxone. Substance Abuse Rehabilitation 2015;6:1‐14. [DOI: 10.2147/SAR.S45585] - DOI - PMC - PubMed
Strang 2005
    1. Strang J, Sheridan J, Hunt C, Kerr B, Gerada C, Pringle M. The prescribing of methadone and other opioids to addicts: national survey of GPs in England and Wales. British Journal of General Practice 2005;55(515):444‐51. - PMC - PubMed
Strike 2013
    1. Strike C, Millson M, Hopkins S, Smith C. What is low threshold methadone maintenance treatment?. International Journal of Drug Policy 2013;24(6):e51‐e56. [DOI: 10.1016/j.drugpo.2013.05.005] - DOI - PubMed
Tompkins 2007
    1. Tompkins C, Neale J, Sheard L, Wright N. Experiences of prison among injecting drug users in England: a qualitative study. International Journal of Prisoner Health 2007;3(3):189‐203. [DOI: ]
Ulmer 1997
    1. Ulmer A. Die Dihydrocodeine‐Substitution [Dihydrocodeine Maintenance Treatment]. Stuttgart: Thieme, 1997.
UNODC 2013
    1. UNODC/WHO. Opioid overdose: preventing and reducing opioid overdose mortality. Discussion Paper. New York: United Nations, 2013.
UNODC 2017
    1. United Nations Office on Drugs and Crime. World Drug Report 2017. Vol. Sales No. E.17.XI.6, Vienna: United Nations, 2017.
UNODC WHO 2013
    1. UNODC/WHO. Opioid overdose: preventing and reducing opioid overdose mortality. Contribution of the United Nations Office on Drugs and Crime and the World Health Organization to improving responses by Member States to the increasing problem of opioid overdose deaths. Discussion Paper 2013.
Vlahov 2004
    1. Vlahov D, Wang CL, Galai N, Bareta J, Mehta SH, Strathdee SA, et al. Mortality risk among new onset injection drug users. Addiction 2004;99(8):946‐54. [DOI: 10.1111/j.1360-0443.2004.00780.x] - DOI - PubMed
Volkow 2017
    1. Volkow ND, Collins FS. The role of science in addressing the opioid crisis. New England Journal of Medicine 2017;337(4):391‐4. - PubMed
Wazaify 2005
    1. Wazaify M, Shields E, Hughes CM, McElnay JC. Societal perspectives on over‐the‐counter (OTC) medicines. Family Practice 2005;22(2):170‐6. - PubMed
Webb 2001
    1. Webb JA, Rostami‐Hodjegan A, Abdul‐Manap R, Hofmann U, Mikus G, Kamali F. Contribution of dihydrocodeine and dihydromorphine to analgesia following dihydrocodeine administration in man: a PK–PD modelling analysis. British Journal of Clinical Pharmacology 2001;52(1):35‐43. [DOI: 10.1046/j.0306-5251.2001.01414.x] - DOI - PMC - PubMed
Weber 2009
    1. Weber R, Huber M, Rickenbach M, Furrer H, Elzi L, Hirschel B, et al. Uptake and virological response to antiretroviral therapy among HIV infected former and current injecting drug users and persons in an opiate substitution treatment program: the Swiss HIV Cohort Study. HIV Medicine 2009;10:407‐16. [DOI: 10.1111/j.1468-1293.2009.00701.x.] - DOI - PubMed
WHO 2009
    1. World Health Organization. Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. Geneva: World Health Organization, 2009. [ISBN: 978 92 4 154754 3] - PubMed
Zamaprutti 2010
    1. Zamparutti G, Schifano F, Corkery JM, Oyefeso A, Ghodse H. Deaths of opiate/opioid misusers involving dihydrocodeine, UK, 1997–2007. British Journal of Clinical Pharmacology 2010;72(2):330‐7. [DOI: 10.1111/j.1365-2125.2011.03908.x] - DOI - PMC - PubMed

References to other published versions of this review

Carney 2016
    1. Carney T, Hout MC, Norman I, Dada S, Parry CD. Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders. Cochrane Database of Systematic Reviews 2016, Issue 6. [DOI: 10.1002/14651858.CD012254] - DOI - PMC - PubMed

Publication types

MeSH terms