S. Liu1, W. Zhou1, F. Zhang1, L. Li1, J. Zhang1, Q. Wang2, D. Gui1, Y. Liu3, D. Cai2, W. Li1, Y. Liu1, W. Shen1. 1Ningbo Addiction Research and Treatment Center, China; 2Addiction Treatment Center, Zhejiang Qingchun Hospital, China; 3Medical School of Ningbo University, China
Background: Medical detoxification addresses only the very first step in treatment of opiate dependence. Detoxification approaches should be assessed in the larger context of long-term relapse prevention. We conducted a randomized controlled trial to determine how combined scopolamine and chlorpromazine for heroin dependence compared with methadone-assisted detoxification.
Methods: A total of 70 treatment-seeking heroin-dependent patients, age 18 through 50, were randomly assigned to scopolamine and chlorpromazine or methadone-assisted inpatient withdrawal treatments over 10 days, followed by 24 weeks of outpatient visits. Thirty-six subjects received scopolamine (0.03–0.05 mg/kg) and chlorpromazine (0.6–1.0 mg/kg) per day over the course of 5–7 days. Thirty-four control subjects received methadone treatment. Withdrawal severity scores on objective and subjective scales, including heroin craving, self-rating anxiety scores, completion of inpatient detoxification and retention in treatment, protracted withdrawal symptoms, and proportion of opioid-positive urine specimens, were measured.
Results: Combined scopolamine and chlorpromazine detoxification was effective as methadone detoxification in the control of abstinence syndrome of heroin. Compared with methadone-assisted detoxification, combined scopolamine and chlorpromazine detoxification had a lower rate of heroin craving 1 day after treatment (2.1±0.4 vs. 4.1±1.1) and 30 days after treatment (4.0±1.5 vs. 5.8±1.2). The groups did not differ in rates of completion of inpatient detoxification. Treatment retention over 24 weeks was not significantly different between the two groups, with 11 of 36 (31%) retained in the scopolamine and chlorpromazine group and 10 of 34 (29%) in the methadone-assisted group. Participants who received scopolamine and chlorpromazine detoxification showed fewer protracted withdrawal symptoms than participants who received methadone detoxification 30 days after treatment. There were no significant group differences in proportions of opioid-positive urine specimens. The primary cause for heroin relapse in the scopolamine and chlorpromazine group was “sleeping disorder” (52.7%), followed by “stress” (27.7%). The primary cause for heroin relapse in the medication-assisted group was “heroin craving” (47.1%), followed by “protracted withdrawal symptoms” (35.5%). Combined scopolamine and chlorpromazine detoxification was associated with a few adverse events, such as dry mouth, physical weakness, blurred vision, hyperhidrosis, insobriety, and fainting.
Conclusion: Compared with methadone-assisted detoxification, scopolamine and chlorpromazine detoxification can suppress more heroin craving but not reduce the relapse rate.