Non-opioid Protocol for Opioid Detoxificaon and/or Transion to Antagonist Treatment Gregory Rudolf, Jim Walsh, Abigail Plawman, Paul Gianutsos, William Alto, Lloyd Mancl, Vania Rudolf Introduction Design & Methods Results Conclusion

Study Objecves Retrospecve chart review study of DSM IV- Percent Retenon and Discharge to This study describes a novel non-opioid diagnosed opioid-dependent individuals admied Treatment detoxificaon protocol that ulizes scheduled A variety of protocols exist for opioid withdrawal 100% zanidine, hydroxyzine, and gabapenn, allowing for inpaent detoxificaon between 1/1/11 and p<0.05 80% for the iniaon of antagonist therapy prior to management. We present a retrospecve chart 11/30/12. A total of 84 (out of 324 total) non- p<0.01 review study of a novel non-opioid detoxificaon opioid and 40 (out of 260 total) bup/nx protocol 60% hospital discharge. Of note, no benzodiazepines or protocol that ulizes zanidine, gabapenn, and other controlled substances are used in this subjects included. Exclusions: polysubstance use, 40% non-opioid hydroxyzine in comparison with a buprenorphine/ bup/nx protocol. discharge to buprenorphine treatment, pregnancy, 20% naltrexone (bup/nx) protocol. medical problems requiring escalaon in care. 0% The non-opioid protocol was found to be superior Retenon D/C to to a bup/nx protocol for treatment retenon and This study assesses treatment retenon, discharge Non-opioid protocol: treatment to further chemical dependency treatment, length • Tizanidine 8 mg po q6 h discharge to further treatment, and was non- of stay, symptom severity, and adverse effects in • Hydroxyzine 100 mg po q4 h inferior for symptom control and length of stay. ancillary both groups. • Average COWS Score by Day Ulizing a non-opioid detox protocol allowed a Gabapenn 300 mg po TID, medicaons 7 greater flexibility in discharge medicaon opons, 600 mg qHS + 6 with more paents from this group receiving standard 5 Background injectable ER naltrexone treatment prior to Buprenorphine/naloxone protocol: counseling 4 Series1 discharge. • Day 1: 2 mg SL q2 h x 3, 8mg SL BID 3 In response to the naonal opioid addicon n Series2 bup/nx • Day 2-3: 8 mg SL COWS Score 2 u non-opioid Series3 epidemic of the past 10 years, addicon medicine • Day 4: 4 mg SL 1 This study excluded polysubstance-using paents, physicians and other clinicians are oen faced with 0 resulng in a smaller but more consistent sample the challenge of opioid withdrawal management. 1 2 3 4 5 6 group. Outcomes: Day • Primary-Treatment retenon (detox Adequate symptomac relief from opioid compleon), discharge to further CD treatment The study’s retrospecve design did not allow for • withdrawal symptoms plays a key role in effecve • Secondary- Length of stay, adverse effects, Non-opioid subjects had a greater treatment direct temporal comparison between groups. management during the early phase of opioid COWS scores, ancillary medicaon use, retenon (p=.026) and discharge to further However, by demonstrang an effecve, novel cessaon, allowing for engagement in behavioral iniaon of injectable ER naltrexone chemical dependency treatment (p=.006) than non-opioid detoxificaon protocol, we offer the treatment and potenal transion to naltrexone bup/nx subjects. treang clinician a useful tool to address the varied antagonist therapy. Tizanidine • COWS scores were similar across both groups; needs of the increasing populaon of opioid- analysis of days 5 and 6 was limited due to • Peripheral a-2 agonist dependent individuals seeking treatment. While various protocols and strategies have been • Reduces myalgias, diaphoresis, tremor, small sample size. • described, such as use of buprenorphine (1), there restlessness, insomnia Incidence of bradycardia was 37 (44%) in non- is no standard evidence-based treatment. A non- • Decreased cardiovascular adverse effects opioid group versus 26 (65%) in the bup/nx opioid and benzodiazepine-free protocol has compared with clonidine group (p=.029). References advantages over opioid-based protocols (2), • A total of 28.6% (95% CI 19 to 40%) in the non- parcularly if transioning to opioid antagonist Hydroxyzine opioid group were transioned successfully to 1. Oreskovich, M. R., A. J. Saxon, et al. (2005). "A double-blind, treatment (3). • Anhistamine (H1), acts on D2 and injectable ER naltrexone treatment. double-dummy, randomized, prospecve pilot study of the 5HT2A • No AMA discharges due to adverse medicaon paral mu opiate agonist, buprenorphine, for acute • effects were reported in either arm. detoxificaon from heroin." Drug Alcohol Depend 77(1): 71-9. Other withdrawal protocols ulize Anxiolyc, an-emec, reduces dysphoria 2. Ling, W., L. Amass, et al. (2005). "A mul-center randomized benzodiazepines or other controlled substances, trial of buprenorphine-naloxone versus clonidine for opioid Gabapenn which can further delay or compromise the goal of No significant difference in: detoxificaon: findings from the Naonal Instute on Drug • Anconvulsant Abuse Clinical Trials Network." Addicon 100(8): 1090-100. addicon recovery. • Asymptomac hypotension (26.2% v. 35%) • Decreases coldness, diarrhea, dysphoria, 3. Minozzi, S., L. Amato, et al. Oral naltrexone maintenance • Symptomac hypotension (8.3% v. 10.%) yawning, muscle tension treatment for opioid dependence. Cochrane Database Syst Rev • Ancillary medicaon use (11.6 v. 11.8 doses) 2006 (1): CD001333. • More effecve at higher doses • Length of stay (3.6 v. 3.4 days)

Swedish Addicon Recovery Service, Seale, WA