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A Meta-Analysis of Chinese Herbal Medicine in Treatment of Managed Withdrawal from Heroin

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Abstract

Chinese herbal medicine has shown promise for heroin detoxification. This review extends a prior meta-analysis of Chinese herbal medicine for heroin detoxification, with particular attention to the time course of symptoms. Both English and Chinese databases were searched for randomized trials comparing Chinese herbal medicine to either α2-adrenergic agonists or opioid agonists for heroin detoxification. The methodological quality of each study was assessed with Jadad’s scale (1–2 = low; 3–5 = high). Meta-analysis was performed with fixed- or random-effect models in RevMan software; outcome measures assessed were withdrawal-symptoms score, anxiety, and adverse effects of treatment. Twenty-one studies (2,949 participants) were included. For withdrawal-symptoms score relieving during the 10-day observation, Chinese herbal medicine was superior to α2-adrenergic agonists in relieving opioid-withdrawal symptoms during 4–10 days (except D8) and no difference was found within the first 3 days. Compared with opioid agonists, Chinese herbal medicine was inferior during the first 3 days, but the difference became non-significant during days 4–9. Chinese herbal medicine has better effect on anxiety relieving at late stage of intervention than α2-adrenergic agonists, and no difference with opioid agonists. The incidence of some adverse effects (fatigue, dizziness) was significantly lower for Chinese herbal medicine than for α2-adrenergic agonists (sufficient data for comparison with opioid agonists were not available). Findings were robust to file-drawer effects. Our meta-analysis suggests that Chinese herbal medicine is an effective and safety treatment for heroin detoxification. And more work is needed to determine the specific effects of specific forms of Chinese herbal medicine.

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References

  • Akhondzadeh S, Kashani L, Mobaseri M, Hosseini SH, Nikzad S, Khani M (2001) Passionflower in the treatment of opiate withdrawal: a double-blind randomized controlled trial. J Clin Pharm Ther 26:369–373. doi:10.1046/j.1365-2710.2001.00366.x

    Article  PubMed  CAS  Google Scholar 

  • Alper KR, Lotsof HS, Frenken GM, Luciano DJ, Bastiaans J (1999) Treatment of acute opioid withdrawal with ibogaine. Am J Addict 8:234–242. doi:10.1080/105504999305848

    Article  PubMed  CAS  Google Scholar 

  • Alper KR, Lotsof HS, Frenken GM, Luciano DJ, Bastiaans J (2000) Ibogaine in acute opioid withdrawal. An open label case series. Ann N Y Acad Sci 909:257–259

    Article  PubMed  CAS  Google Scholar 

  • Amato L, Minozzi S, Davoli M, Vecchi S, Ferri M, Mayet S (2004) Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Database Syst Rev CD005031

  • Cochrane Collaboration 2004. RevMan User Guide. http://www.cc-ims.net/download/revman/Documentation/User%20guide.pdf. Accessed December 21, 2007

  • Deng YP, Shen LY, Gao WY, An YQ, Liu LJ, Duan LX et al (2006) Multi-centered clinical trial of shifusheng capsule for the management of heroin withdrawal. Chin J Drug Depend 15:28–32

    Google Scholar 

  • Ghodse H, Schifano F, Szendrei K, Carver S, Annan J (2006) Herbal medicine in the treatment of addictions. St. George’s Hospital Medical School, Department of Addictive Behavior & Psychological Medicine, London

  • Gonzalez G, Oliveto A, Kosten TR (2002) Treatment of heroin (diamorphine) addiction: current approaches and future prospects. Drugs 62:1331–1343. doi:10.2165/00003495-200262090-00004

    Article  PubMed  CAS  Google Scholar 

  • Guo S, Jiang ZN, Wang YD, Hu GC, Wu YM, Huang MS (1995) A comparative study of Chinese herbal medicine fukangpian with clonidine hydrochloride on opioid withdrawal symptoms. China Bull Drug Depend 4:210–216

    Google Scholar 

  • Guo S, Jiang ZN, Sheng LX (2001) A double-blind clinical trial of zheng tongning vs clonidine hydrochloride of heroin withdrawal symptoms. Chin J Drug Depend 10:111–115

    Google Scholar 

  • Hao W, Zhao M (2000) A comparative clinical study of the effect of WeiniCom, a Chinese herbal compound, on alleviation of withdrawal symptoms and craving for heroin in detoxification treatment. J Psychoactive Drugs 32:277–284

    PubMed  CAS  Google Scholar 

  • Huang P, Wu G, Zhou PL, Wu HJ, Tang YM (2005) Clinical observation on Yianhuisheng koufuye in the treatment of heroin dependence. Pract Clin J Integr Tradit Chin West Med 5:15–16

    Google Scholar 

  • Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12. doi:10.1016/0197-2456(95)00134-4

    Article  PubMed  CAS  Google Scholar 

  • Li J, Huang MS, Wan WP, Tian WC, Liu C, Chen XR et al (1999a) Clinical trials of lingyi capsule in treatment of opioid withdrawal syndrome. W China Med J 14:18–21

    Google Scholar 

  • Li JS, Pei LJ, Zhang XF, Du YZ (1999b) Effect of detoxifying jiedu koufuye on heroin addicts. Med J Chin People’s Armed Police Forces 10:502–504

    Google Scholar 

  • Li J, Kang L, Zhang SS, Li GH, Chen YM, Li KM et al (2002) Double blind and randomized clinical trial on the effect of shenfutuodu capsule compared with clonidine on withdrawal syndrome of heroin addicts. Chin J Drug Depend 11:125–128

    CAS  Google Scholar 

  • Li SC, Li B, Cheng DG, Li F (2005) Advancement of traditional Chinese medicine in opioid dependence. J Beijing Univ Tradit Chin Med 28:84–88

    CAS  Google Scholar 

  • Liu JY, Yang QH, Wu XW (2001) A clinical study on the treatment of heroinism abstinence syndrome by compound yang—warming, qi-invigorating and blood-activating prescription. N J Tradit Chin Med 33:19–22

    Google Scholar 

  • Lu HQ, Wang G, Lan SM, Yuan DF, Zhan CM (1997) Clinial study of “qingjunyin” detoxification for the treatment of heroin addicts. J Chin Med Mater 20:319–321

    CAS  Google Scholar 

  • Lu XJ, Tan GC, Liang F, Ban CT, Li HX (2000) A randomized controlled trial of baokangjiedu decoction vs lofexidine in the treatment of heroin detoxification. Chin J Drug Abuse Prev Treat 6:37–40

    Google Scholar 

  • Mantsch JR, Li SJ, Risinger R, Awad S, Katz E, Baker DA et al (2007) Levo-tetrahydropalmatine attenuates cocaine self-administration and cocaine-induced reinstatement in rats. Psychopharmacology (Berl) 192:581–591. doi:10.1007/s00213-007-0754-7

    Article  CAS  Google Scholar 

  • Min X, Lee DTS, Wong W (2005) meta-analysis on Chinese herbal therapy for heroin withdrawal syndrome. http://www.nd.gov.hk/conference_proceedings/Drugs_proBK_Part5/Drugs_proBK_XuMin1.pdf. Accessed December 21, 2007

  • Min X, Lee DT, Jinhua X, Wenjun D, Li C, Bin D et al (2007) A database on treating drug addiction with traditional Chinese medicine. Addiction 102:282–288. doi:10.1111/j.1360-0443.2006.01660.x

    Article  PubMed  Google Scholar 

  • Mo ZX, Wang CY, Luo XY, Zhang XF (2003) Clinical observation of qingfeng capsule on heroin detoxification. J Chin Med Mater 26:531–533

    Google Scholar 

  • Rosenthal R (1979) The “file drawer problem” and tolerance for null results. Psychol Bull 86:638–641. doi:10.1037/0033-2909.86.3.638

    Article  Google Scholar 

  • Schulteis G, Yackey M, Risbrough V, Koob GF (1998) Anxiogenic-like effects of spontaneous and naloxone-precipitated opiate withdrawal in the elevated plus-maze. Pharmacol Biochem Behav 60:727–731. doi:10.1016/S0091-3057(98)00034-3

    Article  PubMed  CAS  Google Scholar 

  • Sees KL, Delucchi KL, Masson C, Rosen A, Clark HW, Robillard H et al (2000) Methadone maintenance vs 180-day psychosocially enriched detoxification for treatment of opioid dependence: a randomized controlled trial. JAMA 283:1303–1310. doi:10.1001/jama.283.10.1303

    Article  PubMed  CAS  Google Scholar 

  • Sha LJ, Zhang ZX, Cheng LX, Liu J, Zhang ZM (2000) Clinical observation on heroinism (424 cases) treated with xinsheng decoction. Chin J Integr Tradit West Med 20:267–268

    Google Scholar 

  • Shi J, Liu YL, Fang YX, Xu GZ, Zhai HF, Lu L (2006) Traditional Chinese medicine in treatment of opiate addiction. Acta Pharmacol Sin 27:1303–1308. doi:10.1111/j.1745-7254.2006.00431.x

    Article  PubMed  CAS  Google Scholar 

  • Takahashi M, Tokuyama S (1998) Pharmacological and physiological effects of ginseng on actions induced by opioids and psychostimulants. Methods Find Exp Clin Pharmacol 20:77–84. doi:10.1358/mf.1998.20.1.485635

    Article  PubMed  CAS  Google Scholar 

  • Tu QX, Zhao HG, Chen YP, Chen YM, Huang XP, Chen YM et al (1999) Comparison study on clinical efficacy of jitai capsule with lofexidine in the treatment of opioid addicts. Chin J Drug Depend 8:285–288

    Google Scholar 

  • United Nations Office on Drugs and Crime 2007. World drug report. http://www.unodc.org/pdf/research/wdr07/WDR_2007.pdf. Accessed December 21, 2007

  • Wang XP, Liu TQ, Hao W (2002) Efficacy comparison of shenfutuodu capsules and clonidine on treatment of heroin dependence. Chin J Drug Depend 11:120–124

    Google Scholar 

  • Wen L, Zhen YS, Yu LZ, Mo ZX, Ou JW (2000) A clinical study of modified shenfu decoction on 68 cases of heroin addicts. Pharmacol Clin Chin Materia Med 16:40–42

    Google Scholar 

  • Wolfe R, Hanley J (2002) If we’re so different, why do we keep overlapping? When 1 plus 1 doesn’t make 2. CMAJ 166:65–66

    PubMed  Google Scholar 

  • Xu BS, Tie EG, Wang PX, Lv QL, Sun ZW, Jin J et al (2000) A comparative clinical study of qingdubuzheng decoction on heroin addiction. Chin J Drug Abuse Prev Treat 6:6–9

    Google Scholar 

  • Xu GZ, Duan LX, Liu C, Gao WY, Wang ZF, Xu BS et al (2002) A randomized controlled clinical trial of fuzhengkang decoction in the treatment of heroin dependence. Chin J Drug Abuse Prev Treat 8:146–151

    Google Scholar 

  • Yang L, Chen J, Zhang XL, Xu X, Hu ML, Li LJ (2006) Controlled clinical study on paiduyangsheng capsule in detoxification of heroin abuse. Chin J Drug Abuse Prev Treat 12:86–88

    Google Scholar 

  • Zhang RM, Li JX, Sun XH, Zheng L, Yang LP, Zhang J et al (2001) A double-blind clinical trial of shenfutuodu capsule in the treatment of heroin withdrawal symptoms. Chin J Drug Depend 10:197–201

    Google Scholar 

  • Zhang XD, Gou XH, Zhao TS, Yang J, Zhao Q, Yin CB (1998) Clinical study of fufangketonning in heroin dependence. Chin J Drug Abuse Prev Treat 4:45–47

    CAS  Google Scholar 

  • Zhou C, Zhang DR, Wang LQ (2004a) Compared clinical researches on treating opium withdrawal syndrome by TCM complex, yi an decoction, and clonidine. Chin J Drug Abuse Prev Treat 10:68–71

    Google Scholar 

  • Zhou KC, Xie RQ, Liu JG, Zhan XM (2004b) An observation on clinical efficacy of tuoduling capsule in 3-day treatment of heroin dependence. Chin J Drug Abuse Prev Treat 10:97–100

    Google Scholar 

Download references

Acknowledgments

This work was supported in part by the National Basic Research Program of China (973 Program, 2003CB515400), the National High Technology Research and Development Program of China (863 Program, 2006AA02Z4D1), and the China–Canada Joint Health Research Program (No: 30611120528)

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Authors and Affiliations

  1. National Institute on Drug Dependence, Peking University, 38, Xue Yuan Road, Hai Dian District, Beijing, 100083, China

    Ting-ting Liu, Jie Shi, Yan-Ping Bao & Lin Lu

  2. Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, 21224, USA

    David H. Epstein

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  1. Ting-ting Liu
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  2. Jie Shi
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  3. David H. Epstein
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  4. Yan-Ping Bao
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  5. Lin Lu
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Correspondence to Jie Shi or Lin Lu.

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Liu, Tt., Shi, J., Epstein, D.H. et al. A Meta-Analysis of Chinese Herbal Medicine in Treatment of Managed Withdrawal from Heroin. Cell Mol Neurobiol 29, 17–25 (2009). https://doi.org/10.1007/s10571-008-9290-1

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