Low efficacy of non-opioid drugs in opioid withdrawal symptoms


Prof. Karl Mann, MD, Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, J 5, D-68159 Mannheim, Germany. Tel: +49 621 1703 3501; Fax: +49 621 1703 3505; E-mail: sucht@zi-mannheim.de


Opioid withdrawal, stress or cues associated with opioid consumption can induce opioid craving. If opioids are not available, opioid-dependent patients usually search for alternative drugs. Because several non-opioid drugs stimulate the endogenous opioidergic system, this concept may explain their frequent use by opioid-dependent patients. We hypothesized that non-opioid drugs alleviate opioid withdrawal symptoms and are therefore consumed by opioid addicts. We asked 89 opioid-dependent patients participating in an out-patient opioid maintenance program to estimate the potential of several non-opioid drugs in being able to alleviate opioid withdrawal. We applied a five-point Lickert scale (1 = very good reduction of opioid withdrawal; 5 = no reduction of opioid withdrawal). Patients could also indicate a worsening of opioid withdrawal. Values (mean ? SD) were: for benzodiazepines, 3.2 ? 1.1; tricyclic antidepressants, 3.6 ? 1.1; cannabis, 3.6 ? 1.0; alcohol, 4.1 ? 1.1; cocaine, 4.2 ? 1.1; amphetamine, 4.4 ? 0.9; nicotine, 4.7 ? 0.7; and caffeine, 4.9 ? 0.5. A worsening of opioid withdrawal was reported by 62% of the patients for cocaine, 62% for amphetamine, 50% for caffeine, 37.5% for cannabis, 27% for nicotine, 26% for alcohol, 8% for tricyclic antidepressants and 3% for benzodiazepines. Our study shows a low efficacy of non-opioid drugs in alleviating opioid withdrawal symptoms. The data basis of this study was good and the sample was suitable to be asked for estimations of drug-drug interactions. Of the patients, 26 – 62% even reported a worsening of opioid withdrawal for cannabis, alcohol, cocaine and amphetamine. Only benzodiazepines and tricyclic antidepressants were reported to have a moderate positive effect on opioid withdrawal.