18 Clonidine and Lofexidine: New Nonopiate Treatments for Opiate Withdrawal

INTRODUCTION Recent studies (Gold et al, 1978; Washton et al, 1980a) showing that the non-opiate antihypertensive agent, clonidine hydrochloride, suppresses signs and symptoms of opiate withdrawal, have suggested that clonidine and similar drugs might be useful in the clinical management of opiate detoxification. The fact that clonidine is not an opiate drug and does not itself produce addiction or euphoria suggests some unique and potentially useful applications of this medication in the treatment of opiate-dependent persons. For example, clonidine might be used to block the emergence of abstinence symptoms during a gradual methadone detoxification. Clonidine might also serve as a transitional treatment between opiate dependence and induction onto the long-acting opiate antagonist, naltrexone (Resnick et al, 1979). If withdrawal symptoms were controlled by clonidine, patients might be able to abruptly discontinue chronic opiate use and remain abstinent during the minimum 10-day opiate-free period that is required before starting naltrexone aftercare treatment. In general, clonidine might increase the chances of detoxification success and allow patients greater access to naltrexone and drug-free modalities. Since the initial report (Gold et al, 1978) of clonidine's withdrawal-suppressing effects in opiate addicts, a variety of clinical studies have explored the usefulness of this medication in opiate detoxification, as reviewed recently by Washton and Resnick (1981). The present chapter describes the outpatient studies conducted at New York Medical College with patients addicted to heroin and/or methadone. Also described is recent work with lofexidine, an analogue of clonidine that appears to be a safer and more effective non-opiate treatment for opiate withdrawal.