New directions in the treatment of opioid withdrawal. Issue 10241 (20th June 2020)

• Record Type: Journal Article
• Authors: Srivastava, A Benjamin; Mariani, John J; Levin, Frances R
• Is Part Of: Lancet. Volume 395:Issue 10241(2020)
• Page Start: 1938
• Page End: 1948
• Publication Date: 2020-06-20
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(20)30852-7
• Languages: English
• ISSNs: 0140-6736

Abstract

Summary: The treatment of opioid withdrawal is an important area of clinical concern when treating patients with chronic, non-cancer pain, patients with active opioid use disorder, and patients receiving medication for opioid use disorder. Current standards of care for medically supervised withdrawal include treatment with μ-opioid receptor agonists, (eg, methadone), partial agonists (eg, buprenorphine), and α2-adrenergic receptor agonists (eg, clonidine and lofexidine). Newer agents likewise exploit these pharmacological mechanisms, including tramadol (μ-opioid receptor agonism) and tizanidine (α2 agonism). Areas for future research include managing withdrawal in the context of stabilising patients with opioid use disorder to extended-release naltrexone, transitioning patients with opioid use disorder from methadone to buprenorphine, and tapering opioids in patients with chronic, non-cancer pain.