Efficacy of buprenorphine and clonidine in opioid detoxification: A hospital- based study

The Effect of Adding Memantine to Clonidine in Reducing Withdrawal Symptoms in Opioid-Dependent Patients: A Double-Blind Randomized Controlled Trial

OBJECTIVE

Addiction is a complex condition and a brain disease manifested by compulsive substance use despite its harmful consequence. Addicted individuals have an intense focus on using substances. This study aimed to investigate the effect of adding memantine to clonidine and buprenorphine in reducing withdrawal symptoms, compared with placebo, in drug-dependent patients (opium and heroin).

MATERIALS AND METHODS

In this double-blind, randomized clinical trial study, 60 patients using opium or heroin were assigned to the intervention (n = 30) and control (n = 30) groups. Both groups were treated with buprenorphine and clonidine at the same dose in the detoxification process. The intervention group received memantine 10 mg daily for 10 days and then 20 mg daily for 21 days, and the control group received a placebo prepared in the same shape and size as memantine tablets. The severity of withdrawal symptoms was measured using the Short Opioid Withdrawal Scale over 3 weeks. Data analysis was performed using SPSS and descriptive and inferential tests.

RESULTS

The results showed that despite memantine's superiority in controlling some withdrawal symptoms such as feeling sick, stomach pain, muscle spasm, and feeling cold, no significant difference was found between the 2 groups. There was also no statistically significant difference between the 2 groups in the total score of symptoms.

CONCLUSIONS

No specific advantage of memantine was found for reducing the symptoms of withdrawal syndrome in the present study. However, this drug was well tolerated without any evidence of serious or significant adverse effects.

A Practical Approach to Acute Postoperative Pain Management in Chronic Pain Patients

In the United States, more than 100 million people suffer from chronic pain. Among patients presenting for surgery, about one in four have chronic pain. Acute perioperative pain management in this population is challenging because many patients with chronic pain require long-term opioids for the management of this pain, which may result in tolerance, physical dependence, addiction, and opioid-induced hyperalgesia. These challenges are compounded by the ongoing opioid epidemic that has resulted in calls for a reduction in opioid use, with a concurrent increase in the number of patients with chronic opioid exposure presenting for surgery. This article aims to summarize practical considerations for acute postoperative pain management in patients with chronic pain conditions. A patient-centered acute pain management plan, including nonopioid analgesics, regional anesthesia, and careful selection of opioid medications, can lead to adequate analgesia and satisfaction with care. Also, a meticulous rotation from one opioid to another may decrease opioid requirement, increase analgesic effectiveness, and improve satisfaction with care.

Relationship between the Level of Motivation and Personality Disorder in Patients with Opioid Dependence Syndrome

BACKGROUND

The relationship between the level of motivation and personality disorder (PD) in patients with opioid dependence syndrome is understudied.

METHOD

A cross-sectional study was conducted on consecutively selected 100 adult inpatients with opioid dependence syndrome. All participants were assessed on ICD-10-AM Symptom Checklist for Mental Disorders, University of Rhode Island Change Assessment (URICA), Stage of Change Readiness and Treatment Eagerness Scale (SOCRATES 8D), International Personality Disorder Examination (IPDE), and Severity of Opioid Dependence Questionnaire (SODQ).

RESULTS

Most patients expressed the level of motivation at contemplation level, medium level of recognition for the need for change, and high levels of ambivalence and taking steps for change. PD was diagnosed in 40% of the patients. The most common PD identified was dissocial, followed by an emotionally unstable personality disorder-impulsive type. There was no statistically significant difference in URICA, SOCRATES 8D, or SODQ scores in opioid-dependent patients with and without PDs. Patients with severe opioid dependence reported higher readiness to change.

CONCLUSION

Most of the patients with opioid dependence syndrome presenting for treatment are at the contemplation level of motivation. More than one-third of patients with opioid dependence syndrome have PD. A diagnosis of comorbid PD is unrelated to the level of motivation in patients with opioid dependence syndrome. Further multicentric research on personality and PD in a diverse sociocultural population with opioid use disorders is needed.