Prediction of withdrawal symptoms during opioid detoxification

Boukje A. G. Dijkstra, MSc; Paul F. M. Krabbe, PhD; Cor A. J. De Jong, MD, PhD; Cees P. F. van der Staak, PhD

doi:10.5055/jom.2008.0035

Authors

Boukje A. G. Dijkstra, MSc
Paul F. M. Krabbe, PhD
Cor A. J. De Jong, MD, PhD
Cees P. F. van der Staak, PhD

DOI:

https://doi.org/10.5055/jom.2008.0035

Keywords:

substance dependence, opioid, detoxification, withdrawal, prediction

Abstract

Objective: The severity of self-reported withdrawal symptoms varies during detoxification of opioid-dependent patients. The aim of this study is to identify subgroups of withdrawal symptoms within the detoxification trajectory and to predict the severity of withdrawal symptoms on the basis of drug-related and sociodemographic characteristics.
Design and setting: A prospective study carried out in an in-patient setting in four addiction treatment centres in the Netherlands.
Participants: Two hundred opioid-dependent patients who participated in a randomized controlled trial and completed more than 75 percent of the administrations of the subjective opioid withdrawal scales during rapid detoxification.
Intervention and main outcome measure: Main outcome measure was the severity of opioid withdrawal as measured by the subjective opioid withdrawal scale during detoxification (18 measurements). Predictor baseline data were obtained on sociodemographic background, severity of addiction, psychopathology, personality disorder, and craving.
Statistics: Those variables found to be statistically significant in univariate analyses were entered into multivariate regression models to predict the severity of subjective withdrawal.
Results: No distinct subgroups could be identified despite substantial individual variability throughout the detoxification trajectory. The multiple regression results showed only four variables to predict the severity of withdrawal symptoms: baseline withdrawal symptoms, intravenous heroin use in the last 30 days, anxiety, and cluster C personality disorder. The variance explained by these sociodemographic variables was low while the largest amount of variance was explained by baseline withdrawal symptoms (27 percent).
Conclusions: The results of the present study provide evidence that the severity of withdrawal symptoms during detoxification treatment is moderately predicted by the baseline severity of their withdrawal symptoms and not by drug- and patient-related characteristics.

Author Biographies

Boukje A. G. Dijkstra, MSc

Novadic-Kentron, Network for Addiction Treatment Services, St. Oedenrode, the Netherlands; and Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, Nijmegen, the Netherlands.

Paul F. M. Krabbe, PhD

Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.

Cor A. J. De Jong, MD, PhD

Novadic-Kentron, Network for Addiction Treatment Services, St. Oedenrode, the Netherlands; Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, Nijmegen, the Netherlands; and Department of Clinical Psychology, Radboud University Nijmegen, Nijmegen, the Netherlands.

Cees P. F. van der Staak, PhD

Department of Clinical Psychology, Radboud University Nijmegen, Nijmegen, the Netherlands.

References

Scherbaum N, Klein S, Kaube H, et al.: Alternative strategies of opiate detoxification: evaluation of the so-called ultra-rapid detoxification. Pharmacopsychiatry. 1998; 31(6): 205-209.

De Jong CAJ, Laheij RJ, Krabbe PFM: General anaesthesia does not improve outcome in opioid antagonist detoxification treatment: A randomized controlled trial. Addiction. 2005; 100(2): 206-215.

Collins ED, Kleber HD, Whittington RA, et al.: Anesthesiaassisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: A randomized trial. JAMA. 2005; 294(8): 903-913.

Gowing LR, Ali R, White J: Opioid antagonists under heavy sedation or anaesthesia for opioid withdrawal. Cochrane Database Syst Rev. 2006(2): CD002022.

Bell JR, Young MR, Masterman SC, et al.: A pilot study of naltrexone-accelerated detoxification in opioid dependence. Med J Aust. 1999; 171(1): 26-30.

Hensel M, Kox WJ: Safety, efficacy, and long-term results of a modified version of rapid opiate detoxification under general anaesthesia: A prospective study in methadone, heroin, codeine and morphine addicts. Acta Anaesthesiol Scand. 2000; 44(3): 326-333.

Pfab R, Hirtl C, Zilker T: Opiate detoxification under anesthesia: No apparent benefit but suppression of thyroid hormones and risk of pulmonary and renal failure. J Toxicol Clin Toxicol. 1999; 37(1): 43-50.

Smolka M, Schmidt LG: The influence of heroin dose and route of administration on the severity of the opiate withdrawal syndrome. Addiction. 1999; 94(8): 1191-1198.

Farrell M: Opiate withdrawal. Addiction. 1994; 89(11): 1471-1475.

Phillips GT, Gossop M, Bradley B: The influence of psychological factors on the opiate withdrawal syndrome. Br J Psychiatry. 1986; 149: 235-238.

Kosten TA: Cocaine attenuates the severity of naloxoneprecipitated opioid withdrawal. Life Sci. 1990; 47(18): 1617-1623.

Rosen MI, Wallace EA, Sullivan MC, et al.: Use of cocaine to prevent opiate withdrawal. Am J Psychiatry. 1992; 149(11): 1609.

Becker HC: Positive relationship between the number of prior ethanol withdrawal episodes and the severity of subsequent withdrawal seizures. Psychopharmacology (Berl). 1994; 116(1): 26-32.

Malcolm R, Roberts JS, Wang W, et al.: Multiple previous detoxifications are associated with less responsive treatment and heavier drinking during an index outpatient detoxification. Alcohol. 2000; 22(3): 159-164.

Gerra G, Ceresini S, Esposito A, et al.: Neuroendocrine and behavioural responses to opioid receptor-antagonist during heroin detoxification: relationship with personality traits. Int Clin Psychopharmacol. 2003; 18(5): 261-269.

APA: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Revision. Washington, DC: American Psychiatric Association, 2000.

Galanter M, Kleber HD: The American Psychiatric Press Textbook of Substance Abuse Treatment, 2nd ed. Washington, DC: American Psychiatric Press, 1999.

Handelsman L, Cochrane KJ, Aronson MJ, et al.: Two new rating scales for opiate withdrawal. Am J Drug Alcohol Abuse. 1987; 13(3): 293-308.

Dijkstra BA, Krabbe PF, Riezebos TG, et al.: Psychometric evaluation of the Dutch version of the Subjective Opiate Withdrawal Scale (SOWS). Eur Addict Res. 2007; 13(2): 81-88.

Kokkevi A, Hartgers C: EuropASI: European Adaptation of a Multidimensional Assessment Instrument for Drug and Alcohol Dependence. Eur Addict Res. 1995; 4: 208-211.

Arrindell WA, Ettema JHM: Klachtenlijst SCL-90 (Symptom Checklist-90). The Netherlands: Lisse: Swets Test Services, 1986.

Pfohl B, Blum N, Zimmerman M: Structured Interview for DSM-IV Personality Disorders (SIDP-IV). Washington, DC: American Psychiatric Press, 1997.

Damen KF, De Jong CA, van der Kroft PJ: Interrater reliability of the structured interview for DSM-IV personality in an opioiddependent patient sample. Eur Addict Res. 2004; 10(3): 99-104.

Damen KF, De Jong CA, Breteler MH, et al.: Construct validity of the SIDP-IV in an opioid-dependent patient sample. J Subst Use. 2005; 10(1): 1-9.

Franken IH, Hendriks VM, van den Brink W: Initial validation of two opiate craving questionnaires the obsessive compulsive drug use scale and the desires for drug questionnaire. Addict Behav. 2002; 27(5): 675-685.

Dempster AP, Laird NM, Rubin DB: Maximum likelihood from incomplete data via the EM algorithm. J Royal Stat Soc Series B (Methodological). 1977; 39(1): 1-38.

Krabbe PF: Valuation structures of health states revealed with singular value decomposition. Med Decis Making. 2006; 26(1): 30-37.

Department of Health: Drug Misuse and Dependence: Guidelines on clinical management. London: HMSO, 1999.

Green S: How many subjects does it take to do: A regression analysis. Multivar Behav Res. 1991; 26(3): 499-510.

Gowing LR, Ali RL, White JM: Systematic review processes and the management of opioid withdrawal. Aust N Z J Public Health. 2000; 24(4): 427-431.

Gossop M, Bradley B, Phillips GT: An investigation of withdrawal symptoms shown by opiate addicts during and subsequent to a 21-day in-patient methadone detoxification procedure. Addict Behav. 1987; 12(1): 1-6.

NDM: National Drug Monitor Annual Report 2006. Utrecht, The Netherlands: Trimbos Institute, 2007.

NDM: National Drug Monitor Annual Report 2007. Utrecht, The Netherlands: Trimbos Institute, 2008.