Buydens-Branchey Laure, Branchey Marc, Reel-Brander Christine
New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, NY 11209, USA.
J Clin Psychopharmacol. 2005 Jun;25(3):230-6. doi: 10.1097/01.jcp.0000162804.38829.97.
In an attempt to develop a new opiate detoxification approach, the authors assessed the efficacy of buspirone in the treatment of acute heroin withdrawal. Buspirone, a drug interacting with the serotonergic system, was selected because there is evidence that a decrease in serotonergic neurotransmission may be involved in opiate withdrawal symptoms. Twenty-nine hospitalized heroin addicts were randomized to 4 groups: (1) placebo; (2) methadone; (3) buspirone 30 mg daily; (4) buspirone 45 mg daily. The double-blind trial started in all patients with a 5-day methadone stabilization period ending with a 30-mg dose. This was followed from days 6 through 12 by placebo in group 1 and by a methadone taper in group 2. Because of its delayed action, buspirone was started on day 1 in groups 3 and 4 and was continued, after methadone discontinuation, through day 12. On day 13, drugs and placebo were discontinued and patients were observed through day 14. Withdrawal symptoms were assessed with the "Subjective Opiate Withdrawal Scale" (SOWS) and the "Objective Opiate Withdrawal Scale" (OOWS). The SOWS and OOWS scores were significantly higher in the placebo group than in the methadone, buspirone 30 mg, and buspirone 45 mg groups. There were no significant differences in SOWS or OOWS scores when the methadone group was compared with each of the two buspirone groups or when the two buspirone groups were compared with one another. In conclusion, buspirone, a nonopiate drug with no abuse potential, a safe side effect profile and no withdrawal symptoms, at doses of 30 and 45 mg, was as effective as a methadone taper in alleviating the withdrawal symptoms of heroin addicts stabilized for 5 days with, and then withdrawn from, methadone. The use of buspirone could be particularly helpful in outpatient settings where the duration of the methadone taper recommended for detoxification can be lengthy.
为了开发一种新的阿片类药物脱毒方法，作者评估了丁螺环酮治疗急性海洛因戒断的疗效。丁螺环酮是一种与血清素能系统相互作用的药物，之所以选择它，是因为有证据表明血清素能神经传递的减少可能与阿片类药物戒断症状有关。29名住院海洛因成瘾者被随机分为4组：（1）安慰剂组；（2）美沙酮组；（3）每日30毫克丁螺环酮组；（4）每日45毫克丁螺环酮组。双盲试验在所有患者中开始，有一个为期5天的美沙酮稳定期，以30毫克剂量结束。从第6天到第12天，第1组服用安慰剂，第2组逐渐减少美沙酮剂量。由于丁螺环酮作用延迟，第3组和第4组在第1天开始服用丁螺环酮，并在停用美沙酮后持续到第12天。在第13天，停用药物和安慰剂，对患者观察到第14天。使用“主观阿片类药物戒断量表”（SOWS）和“客观阿片类药物戒断量表”（OOWS）评估戒断症状。安慰剂组的SOWS和OOWS评分显著高于美沙酮组、30毫克丁螺环酮组和45毫克丁螺环酮组。当美沙酮组与两个丁螺环酮组中的每一组进行比较时，或者当两个丁螺环酮组相互比较时，SOWS或OOWS评分没有显著差异。总之，丁螺环酮是一种无滥用潜力、副作用安全且无戒断症状的非阿片类药物，剂量为30毫克和45毫克时，在缓解用美沙酮稳定5天后然后停用美沙酮的海洛因成瘾者的戒断症状方面与逐渐减少美沙酮剂量的效果相同。在门诊环境中，推荐用于脱毒的美沙酮逐渐减量的持续时间可能很长，使用丁螺环酮可能会特别有帮助。
