Combining psychosocial and pharmacological treatments for opioid detoxification

Psychosocial treatments added to pharmacological opioid detoxification treatments appear to be effective in terms of completion of treatment, results at follow-up and compliance.

A Cochrane review included 11 studies on the effectiveness of any psychosocial plus any pharmacological interventions versus any pharmacological alone for opioid detoxification, with a total of 1 592 subjects.

The studies considered psychosocial interventions like contingency management, behavioural therapy, psychiatric, employment and family therapies, or counselling, and two substitution detoxification treatments: methadone and buprenorphine. Compared to any pharmacological treatment alone, the association of any psychosocial with any pharmacological was shown to significantly reduce dropouts RR 0.71 (95% CI 0.59 to 0.85), use of opiate during the treatment, RR 0.82 (95% CI 0.71 to 0.93), at follow up RR 0.66 (95% IC 0.53 to 0.82) and clinical absences during the treatment RR 0.48 (95%CI 0.38 to 0.59). Moreover, with the evidence currently available, there are no data supporting a single psychosocial approach.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity of the assessment of outcomes).

Ədəbiyyat

1. Amato L, Minozzi S, Davoli M, Vecchi S, Ferri M, Mayet S. Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Database Syst Rev 2004 Oct 18;(4):CD005031 (Last assessed as up-to-date: 17 July 2011).