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Review: methadone dose reduction is better than α2 adrenergic agonists for treatment retention in opioid dependence

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QUESTION: In patients with opioid dependence, are α2 adrenergic agonists more effective than the reduction of methadone doses for managing opioid withdrawal?

Data sources

Studies were identified by searching 12 databases; hand searching reviews, reference lists, and conference proceedings; and contacting pharmaceutical companies.

Study selection

Studies in any language were selected if they were controlled clinical trials that compared α2 adrenergic agonists with each other, another treatment, or placebo for managing opioid withdrawal in patients who were opioid dependent.

Data extraction

Data were extracted on study design and setting, participant characteristics, drug regimens, and outcomes.

Main results

13 studies (11 randomised controlled trials [RCTs]) fufilled the criteria. 10 studies compared methadone dose reduction with α2 adrenergic agonists (6 comparisons of clonedine, 3 of lofexidine, and 2 of guanfacine), and 3 RCTs compared lofexidine with clonidine. Intensity of …

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