Cochrane · systematic review · CD002024
Alpha₂‐adrenergic agonists for the management of opioid withdrawal
Gowing, L, Farrell, M, Ali, R, et al. · Cochrane Database of Systematic Reviews · 2016 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
10
current version
GRADE rated
9
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 1 · 10%Very low 0 · 0%Low 5 · 50%Moderate 4 · 40%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyAlpha2‐adrenergic agonist versus methadone for the management of opioid withdrawal
Population: People undergoing managed opioid withdrawal
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants with severe withdrawal Alpha2‐adrenergic agonist vs methadone | RR 1.18 [0.81, 1.73] | 5 studies · 340 participants | Low Downgraded: risk of bias, imprecision |
Peak withdrawal score Alpha2‐adrenergic agonist vs methadone | no estimate extracted | 2 studies · 263 participants | Moderate Downgraded: imprecision |
Overall withdrawal severity Alpha2‐adrenergic agonist vs methadone | no estimate extracted | 3 studies · 119 participants | Moderate Downgraded: imprecision |
Duration of treatment Alpha2‐adrenergic agonist vs methadone | no estimate extracted | 3 studies · 310 participants | Low Downgraded: risk of bias, imprecision |
Number experiencing hypotensive or other adverse effects Alpha2‐adrenergic agonist vs methadone | RR 1.92 [1.19, 3.1] | 6 studies · 464 participants | Low Downgraded: risk of bias, imprecision |
Drop‐out due to adverse effects Alpha2‐adrenergic agonist vs methadone | RR 3.62 [0.77, 16.94] | 4 studies · 153 participants | Low Downgraded: imprecision |
Completion of treatment Alpha2‐adrenergic agonist vs methadone | RR 0.85 [0.69, 1.05] | 9 studies · 659 participants | Low Downgraded: risk of bias, inconsistency |
Alpha2‐adrenergic agonist versus placebo for the management of opioid withdrawal
Population: People undergoing managed opioid withdrawal
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants with severe withdrawal Alpha2‐adrenergic agonist vs placebo | RR 0.32 [0.18, 0.57] | 3 studies · 148 participants | Moderate Downgraded: imprecision |
Completion of treatment Alpha2‐adrenergic agonist vs placebo | RR 1.95 [1.34, 2.84] | 3 studies · 148 participants | Moderate Downgraded: imprecision |
1Small number of events. Alpha2‐adrenergic agonist vs placebo | no estimate extracted | 1 participants | Ungraded |
Alpha2‐adrenergic agonist versus methadone for the management of opioid withdrawal
Population: participants with the management of opioid withdrawal
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants with severe withdrawal Alpha2‐adrenergic agonist vs methadone | RR 1.18 [0.81, 1.73] | 5 studies · 340 participants | Low Downgraded: risk of bias, imprecision |
Peak withdrawal score Alpha2‐adrenergic agonist vs methadone | no estimate extracted | 2 studies · 263 participants | Moderate Downgraded: imprecision |
Overall withdrawal severity Alpha2‐adrenergic agonist vs methadone | no estimate extracted | 3 studies · 119 participants | Moderate Downgraded: imprecision |
Duration of treatment Alpha2‐adrenergic agonist vs methadone | no estimate extracted | 3 studies · 310 participants | Low Downgraded: risk of bias, imprecision |
Number experiencing hypotensive or other adverse effects Alpha2‐adrenergic agonist vs methadone | RR 1.92 [1.19, 3.1] | 6 studies · 464 participants | Low Downgraded: risk of bias, imprecision |
Drop‐out due to adverse effects Alpha2‐adrenergic agonist vs methadone | RR 3.62 [0.77, 16.94] | 4 studies · 153 participants | Low Downgraded: imprecision |
Completion of treatment Alpha2‐adrenergic agonist vs methadone | RR 0.85 [0.69, 1.05] | 9 studies · 659 participants | Low Downgraded: risk of bias, inconsistency |
Alpha2‐adrenergic agonist versus placebo for the management of opioid withdrawal
Population: participants with the management of opioid withdrawal
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants with severe withdrawal Alpha2‐adrenergic agonist vs placebo | RR 0.32 [0.18, 0.57] | 3 studies · 148 participants | Moderate Downgraded: imprecision |
Completion of treatment Alpha2‐adrenergic agonist vs placebo | RR 1.95 [1.34, 2.84] | 3 studies · 148 participants | Moderate Downgraded: imprecision |
Small number of events. Alpha2‐adrenergic agonist vs placebo | no estimate extracted | 1 participants | Ungraded |
Adrenergic agonist versus methadone
Population: patients with the management of opioid withdrawal
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participants with unacceptably high withdrawal Adrenergic agonist vs methadone | RR 1.46 [0.86, 2.46] | 4 studies · 347 participants | Moderate Downgraded: risk of bias, imprecision |
Duration of treatment Adrenergic agonist vs methadone | no estimate extracted | 3 studies · 311 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Retention in treatment Adrenergic agonist vs methadone | RR 0.81 [0.64, 1.04] | 5 studies · 399 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Number experiencing adverse effects Adrenergic agonist vs methadone | RR 2.13 [1.3, 3.48] | 7 studies · 525 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Dropout due to adverse effects Adrenergic agonist vs methadone | OR 3.96 [0.79, 19.75] | 4 studies · 153 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Completion of treatment Adrenergic agonist vs methadone | RR 0.95 [0.81, 1.12] | 10 studies · 688 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Adrenergic agonist versus placebo
Population: patients with management of opioid withdrawal
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Completion of treatment Adrenergic agonist vs placebo | RR 1.9 [1.28, 2.81] | 3 studies · 149 participants | Low Downgraded: risk of bias |