Buprenorphine detox more effective than dihydrocodeine
Many opiate users entering prison require medication to aid detoxification. A study carried out at Leeds prison found buprenorphine to be significantly more effective than dihydrocodeine at producing opiate-negative urine samples at five days.
The study took the form of an open-label randomised controlled trial. Newly received male prisoners, aged 18-65, with a history of illicit opiate use confirmed by urine toxicology, were eligible for inclusion. When recruitment proved disappointing in the first few months, the research team offered inducements of £5, credited to the prisoner's phone account, to those who agreed to take part. A total of 96 prisoners, mean age 29 years, were randomised to receive dihydrocodeine or buprenorphine. Participants had used illicit opiates for a mean of 9 years prior to the study.
Five days post-detoxification 63 participants provided a urine sample. Of these, 57% of those who had received buprenorphine were negative for opiates, compared with 35% of those treated with dihydrocodeine. There were no significant differences in abstinence on urine testing at 1, 3 and 6 months; however an increasingly small percentage of participants remained abstinent through the study period.
The study supports the result of an earlier sister trial in the community in which buprenorphine was a more effective detoxification agent than dihydrocodeine. When choosing prescribed detoxification support in either community or secure environments GPs should not routinely use dihydrocodeine. GPs need to be aware of the high rate of relapse to opiate use following prison-based detoxification.
Sheard L, Wright NMJ, El-Sayeh HG, et al. The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS) prisons project: a randomised controlled trial comparing dihydrocodeine and buprenorphine for opiate detoxification. Substance Abuse Treatment, Prevention, and Policy 2009,4:1Reviewer
Dr Jez Thompson
Former GP and Clinical Director, NHS Hull Social Inclusion Services