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The 118 participants began the trial on buprenorphine. Once abstinent from opioids for two weeks, they were randomized to either clonidine or placebo. Clonidine is already used in opioid withdrawal and does not have special prescribing requirements like buprenorphine or methadone.
Overall, clonidine lengthened the time to opioid lapse (defined as a positive or missing urine test), but not significantly. However, after controlling the results for cocaine use, the researchers found that taking clonidine “significantly increased the time to initial opioid lapse.” Time to relapse (two or more lapses) was not extended significantly, possibly because of the priming effect of the drug use in the first lapse.
As part of the trial protocol, participants received small electronic devices that prompted them four times a day to record stress, mood, craving, and any drug-related cues around them.
This “ecological momentary assessment” demonstrated that clonidine “partly decoupled daily-life stress, but not daily-life drug-cue exposure, from increases in drug craving,” said Kowalczyk. “Participants in the clonidine group were less likely than those in the placebo group to report heroin craving at moderately high levels of stress.”
Use of the ecological momentary assessment also added to evidence supporting animal models of stress and drug use and may help individualize treatment by identifying patients who lapse because of stress rather than drug cues or priming doses.
For more in Psychiatric News about pharmacotherapies for drug addiction, see “Psychiatrists Describe Trends in Medications to Treat Addiction.”
--aml (Image: Evdokimov Maxim/Shutterstock.com)