Effectiveness of interventions on opiate withdrawal treatment: an overview of systematic reviews

Aim: To provide an overview of 5 Cochrane reviews of different approaches for treating opioid withdrawal. Design: Narrative and quantitative summary of review findings. Participants: There were 46 studies included in the original reviews with a total of 3350 participants (range 18-300). Intervention: The 5 reviews considered 46 studies covering seven different comparisons, the major ones being methadone compared with alpha(2)-adrenergic agonists and other opioid agonists, different alpha(2)-adrenergic agonists compared with each other and to antagonist-induced withdrawal and buprenorphine. Measurements: The outcomes considered were signs and symptoms of withdrawal, retention in treatment, completion rate, relapse rate and side effects. Findings: Methadone detoxification results in higher retention in treatment, lower relapse rate and fewer side effects when compared with adrenergic agonists. No difference was observed when comparing different adrenergic agonists; buprenorphine appears to have an advantage over adrenergic agonists on withdrawal symptoms and side effects. Conclusions: Despite the considerable number of trials that have been carried out on this topic, they are very heterogeneous as far as the comparisons and outcomes considered. This prevented many of them from being incorporated into a quantitative meta-analysis. Consensus in measurements and results should be reached among researchers involved in the evaluation of the effectiveness of treatments for opiate addiction in order to produce consistent outcomes in the measuring and reporting of results from clinical trials. (C) 2003 Elsevier Ireland Ltd. All rights reserved.