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. 2023 Apr 28;4(2):139-149.
doi: 10.36518/2689-0216.1498. eCollection 2023.

A Retrospective Comparison of the Effectiveness of Buprenorphine Versus Baclofen for Acute Opioid Withdrawal

Matthew Hermenau  1 , Benton Stamper  2 , Kitty Leung  2 , Raymond Pomm  3 , Christina Guerrier  4 , Joseph Cammilleri  5 , Brittany Johnson  2
Affiliations

A Retrospective Comparison of the Effectiveness of Buprenorphine Versus Baclofen for Acute Opioid Withdrawal

Matthew Hermenau et al. HCA Healthc J Med. .

Abstract

Background: A significant impediment to opioid cessation or dose reduction is mitigating withdrawal severity that has been shown to affect the course of opioid dependence. Current guidelines recommend the use of buprenorphine and methadone over alpha-2 adrenergic agonists. Baclofen, a GABA-B agonist, has promising results as an adjunct agent for opioid withdrawal but has not been compared to buprenorphine. This study compared the ability of buprenorphine and baclofen to mitigate acute opioid withdrawal.

Methods: This was a single-center, retrospective chart review of 63 patients with diagnosed opioid use disorder that received scheduled buprenorphine or baclofen for 3 days, in addition to as-needed medications during 2 distinct time periods (pre-2017 and 2017-2020). Patients were admitted to the inpatient detoxification unit at Gateway Community Services in Jacksonville, FL.

Results: The results showed that patients achieving detoxification success were 11.2 times more likely to be exposed to baclofen than buprenorphine (95% CI 3.32 - 37.83, P < .001). Completion of detoxification protocol (baclofen 63.2% vs buprenorphine 72%, P = .649) and incidence of orthostatic hypotension (15.8% versus 0%, P = .073) were not significantly different between the 2 groups.

Conclusion: Patients treated with baclofen had a lower frequency of secondary medication use for acute opioid withdrawal than patients treated with buprenorphine. This raises an interesting question of whether baclofen is comparable to buprenorphine for treating opioid withdrawal. A prospective, randomized, controlled trial in a larger patient population is warranted to determine this difference.

Keywords: baclofen; buprenorphine; inpatient detoxification; opioid withdrawal; opioid-related disorders; opioid-related disorders/therapy; substance abuse treatment centers; substance withdrawal syndrome.

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Conflict of interest statement

Conflicts of Interest The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
A flowchart shows Gateway Community Services protocol for acute opioid withdrawal intake. *If patient experiences severe withdrawal; †Clonazepam, lorazepam, chlordiazepoxide; ‡Antidiarrheal, anti-nausea, constipation, muscle aches/pain
Figure 2
Figure 2
A flowchart shows patient inclusion and exclusion criteria during the study period.
See this image and copyright information in PMC

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