Comparison of tincture of opium and methadone to control opioid withdrawal in a Thai treatment centre

doi:10.1111/j.1365-2125.2004.02209.x

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Wiley InterScience

British Journal of Clinical Pharmacology

Volume 58 Issue 5, Pages 536 - 541

Published Online: 3 Sep 2004

The Journal of The British Pharmacological Society

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Comparison of tincture of opium and methadone to control opioid withdrawal in a Thai treatment centre

Jaroon Jittiwutikarn ¹ , Robert Ali ^2,3 , Jason M. White ^2,3 , Felix Bochner ^3,4 , Andrew A. Somogyi ^3,4 & David J. R. Foster ³

¹ Northern Drug Dependence Centre, Chiang Mai Province, Thailand , ² Drug and Alcohol Services Council of South Australia, Adelaide , ³ Department of Clinical and Experimental Pharmacology, University of Adelaide, Adelaide and ⁴ Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia

Correspondence to Professor Jason White, Department of Clinical and Experimental Pharmacology, University of Adelaide, Adelaide 5005, Australia.
Tel: + 61 88303 5571
Fax: + 61 88224 0685
E-mail: jason.white@adelaide.edu.au

KEYWORDS

methadone • opioid withdrawal • Thailand • tincture of opium

ABSTRACT

Aims

To evaluate the effectiveness of oral tincture of opium (TOP) and methadone to control opioid withdrawal in patients in northern Thailand.

Methods

Open label, parallel group study in an inpatient facility compared 15 former heroin users receiving methadone 5–20 mg 12 hourly with 15 former opium smokers receiving TOP (3.33–10 mg morphine equivalents 12 hourly). At 0, 1, 3 and 8 h, blood, withdrawal scores and subjective opioid effects were collected.

Results

There was a reciprocal association between withdrawal scores/direct subjective opioid effects and plasma (R)-methadone, but not plasma morphine, concentrations. Withdrawal scores at the time of dosing were higher in the TOP patients (9.1 ± 3) than in the methadone patients (4.5 ± 4.6) and in the TOP patients were significantly (P = 0.001) attenuated at 3 and 8 h.

Conclusions

At the doses used, TOP was inferior to methadone in suppressing withdrawal. It could prove to be a cost effective and valuable drug, but only after dose size and frequency are further investigated.

Received 4 November 2003 Accepted 21 April 2004

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1365-2125.2004.02209.x About DOI