Opioid withdrawal and its stabilization on sublingual buprenorphine in intravenous drug users: A south Gujarat perspective

Abstract

Opioid substitution therapy involves replacing the client's primary drug of use (opioid) with a medically safe drug or the same opioid in a safer mode of administration under medical supervision. Objectives and methodology: It is a prospective follow up study observing opioid withdrawal and its stabilization on buprenorphine sublingual tablets. Patients who fulfilled the criteria for Opioid substitution therapy by NACO guidelines were enrolled and given buprenorphine sublingual tablets; (0.2 mg and 2 mg). They were followed up on 1st to 3rd, 7th, 14th and 28th day for assessment of withdrawal and its resolution on buprenorphine. The withdrawal was assessed using Clinical Opioid Withdrawal Scale (COWS). Duration of study was 2 years. Results and conclusions: Total 44 patients were enrolled. 37 IDU users completed the period of observation. They belonged to 19 to 52 years age group, the duration of use ranged from 2 to 32 years. Patients had mild to moderate range of withdrawal. The mean score of COWS was 11.2 with a range of 5 to 24. Mean buprenorphine dose requirement on 1st day was 6.19 mg with range from 1.2 mg to 14 mg. Dose requirement at day 28 was in the range from 0.6 to 16mg. This study is empirical information on the issue of a reference dosage for buprenorphine regimen in an Indian population. We found that dosages required in our study population were lesser that dosage guidelines in western countries. However further research on such lines is required to suggest guidelines for Indian population.