Clonidine Increases Likelihood of Abstinence in Buprenorphine-Maintained Patients Facing Risky Amounts of Structured Time

  • Authored by members of the Center for the Clinical Trials Network, in collaboration with the NIDA Intramural Research Program, this article reports on a clinical trial that found that adding clonidine to buprenorphine treatment for opioid dependence increased abstinence and decoupled stress from craving.
  • Using data from the trial, this study examined the associations of daily-life activities with treatment success, in an attempt to better identify people for whom clonidine would be beneficial.

    Outpatients (N=118) received clonidine (0.3 mg/d) or placebo during 18 weeks of buprenorphine treatment. Participants carried a smartphone that randomly prompted them 4 times per day to report their moods and activities.

    Using generalized linear mixed models, the authors assessed the likelihoods of different types of daily activity as a function of clonidine versus placebo, days of longest continuous opioid abstinence, and their interaction.

    Participants in the buprenorphine-only (buprenorphine plus placebo) control group who engaged in more responsibilities (work and child/elder care, e.g.) had longer streaks of abstinence, whereas those who engaged in more unstructured-time activities had shorter streaks of abstinence.

    Conversely, for participants in the buprenorphine-plus-clonidine group, longer streaks of abstinence were associated with higher frequencies of activities associated with “unstructured” time.

    Conclusions: The study replicates findings that engaging in responsibilities is related to positive treatment outcomes in standard opioid agonist therapy. For participants in the buprenorphine-only group, engaging in more activities related to responsibilities for others was associated with better outcomes, whereas more unstructured uses of time were associated with poorer outcomes. Clonidine seemed to protect participants from this effect, however, a finding that suggests it should be helpful not just for people undergoing moderate stress, but also for clients in recovery who, due to underemployment or social isolation, face possibly risky amounts of unstructured time. A randomized or microrandomized trials with some experimental control over momentary activities would be needed to confirm this hypothesis.

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    Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

    Articles were written based on the following published research:

    Kowalczyk WJ, et al. Clonidine increases the likelihood that abstinence can withstand unstructured time in buprenorphine-maintained outpatients. Journal of Addiction Medicine 2017 (in press).