Three methods of opioid detoxification in a primary care setting. A randomized trial

Ann Intern Med. 1997 Oct 1;127(7):526-30. doi: 10.7326/0003-4819-127-7-199710010-00004.


Background: Opioid detoxification in a primary care setting followed by ongoing substance abuse treatment may be appropriate for selected opioid-dependent patients.

Objective: To compare three pharmacologic protocols for opioid detoxification in a primary care setting.

Design: Randomized, double-blind clinical trial with random assignment to treatment protocols.

Setting: A free-standing primary care clinic affiliated with drug treatment programs.

Patients: 162 heroin-dependent patients.

Interventions: Three detoxification protocols: donidine, combined donidine and naltrexone, and buprenorphine.

Measurements: Successful detoxification (that is, when study participants received a full opioid-blocking dose [50 mg] of naltrexone), treatment retention (8 days), and withdrawal symptoms.

Results: Overall, 65% of participants (36 of 55) who received clonidine, 81% (44 of 54) who received combined clonidine and naltrexone, and 81% (43 of 53) who received buprenorphine were successfully detoxified. Retention did not differ significantly across the groups: 65% of participants (36 of 55) who received clonidine, 54% (29 of 54) who received combined clonidine and naltrexone, and 60% (32 of 53) who received buprenorphine. Participants who received buprenorphine had a significantly lower mean withdrawal symptom score than those who received clonidine or combined clonidine and naltrexone.

Conclusions: Participants in the combined clonidine and naltrexone group and those in the buprenorphine group were more likely to complete detoxification, although retention at 8 days did not differ among the groups. Participants who were assigned to the buprenorphine group experienced less severe withdrawal symptoms than those assigned to the other two groups.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adrenergic alpha-Agonists / therapeutic use*
  • Adult
  • Buprenorphine / therapeutic use*
  • Clonidine / therapeutic use*
  • Double-Blind Method
  • Drug Therapy, Combination
  • Female
  • Heroin / pharmacokinetics
  • Heroin Dependence / drug therapy*
  • Heroin Dependence / metabolism
  • Humans
  • Inactivation, Metabolic
  • Male
  • Middle Aged
  • Naltrexone / therapeutic use*
  • Narcotic Antagonists / therapeutic use*
  • Primary Health Care*
  • Substance Withdrawal Syndrome


  • Adrenergic alpha-Agonists
  • Narcotic Antagonists
  • Buprenorphine
  • Naltrexone
  • Heroin
  • Clonidine