Patient selection buprenorphine

As mentioned earlier in the chapter, in the UK lofexidine is far more frequently selected in opiate detoxification than clonidine because of its better safety for outpatients, and a large comparative study of this and buprenorphine was carried out by Raistrick et al. (2005). Two hundred and ten patients were randomized, and the same comparisons in standard drug misuse outcomes and satisfaction measures were also studied in 271 individuals who did not wish to be in the randomized study. Many outcomes were similar with the two medications, but 65% of buprenorphine patients completed detoxification against 46% of those on lofexidine. That study was an example of one which included a follow-up to see whether patients had been abstinent after detoxification, with this being the case at the measurement point of one month for 38% of lofexidine completers and 46% with buprenorphine. This important aspect of whether successful detoxification does indeed lead to further abstinence has attracted attention in several buprenorphine studies, as reviewed by Horspool et al. (2008). Across five qualifying studies, they found detoxification completion rates of 65 to 100%, but low rates of abstinence at follow-up points, with more patients having returned to opioid maintenance than had complied with naltrexone. 

Answer B. Buspirone has selective anxiolytic activity that is slow in onset The drug has no abuse liability and will not suppress withdrawal symptoms in patients who have become physically dependent on barbiturates, benzodiazepines, or ethanol. Bupropion is an antidepressant, also approved for management of dependence on nicotine. Baclofen is a spinal cord muscle relaxant that activates GABAfi receptors. Buprenorphine is a long-acting opioid analgesic with no effectiveness in GAD, and butabarbital is a barbiturate that may cause dependence. 

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