Buprenorphine in the emergency department: Randomized clinical controlled trial of clonidine versus buprenorphine for the treatment of opioid withdrawal.

OBJECTIVE: To compare buprenorphine to clonidine for the treatment of opioid withdrawal in the emergency department (ED) and to study the effect assigned treatment medication had on longer-term addiction treatment outcomes. DESIGN: Randomized controlled trial. SETTING: Toronto, Ont. PARTICIPANTS: Twenty-six patients presenting to the ED while in opioid withdrawal or soon to be in opioid withdrawal. MAIN OUTCOME MEASURES: Patients were randomized to receive either clonidine or buprenorphine treatment. Both groups also received a corresponding discharge prescription and information on how to follow up in the addictions rapid access clinic (RAC) within a few days. Participants were followed for 1 month with respect to attendance at the RAC and to opioid agonist treatment status. Outcome measures included attendance at the RAC within 5 days of the initial ED visit and opioid agonist treatment status at 1 month (as determined by clinic attendance or self-report during a follow-up telephone interview). RESULTS: Participants who received buprenorphine in the ED were more likely to be receiving opioid agonist treatment at the 1-month mark compared with those participants who received clonidine to treat their withdrawal (P = .011). CONCLUSION: When opioid withdrawal is treated with buprenorphine in the ED, patients are more likely to be receiving opioid agonist treatment and connected with addiction treatment 1 month later. TRIAL REGISTRATION NUMBER: NCT03174067 (ClinicalTrials.gov).