Comparing Methadone and Tincture of Opium for the Management of Opioid Withdrawal among Subjects with an Opioid Use Disorder

Main Article Content

Mohammad Jamalian
Milad Nasrollahzadeh
Amir Mohammad Kazemifar
Hasan Solhi


Introduction: Drug addiction is associated with complications such as mortality, monetary burden, and various socioeconomic problems at the individual to the community level. Methadone and Tincture of Opium (TOP) are the most commonly used drugs to help addicts maintain their drug withdrawal process and eventually permanent withdrawal. Desirable clinical experiences have been reported in the use of these two agents in the management of opioid withdrawal. The purpose of this study was to compare the efficacy of methadone and TOP using Khomree method for detoxification of drug abuse.

Materials and Methods: This study was a randomized double-blind clinical trial among opium addicts (at least one year of use) referred to Arak University of Medical Sciences. Seventy subjects were enrolled in the study according to inclusion and exclusion criteria and then randomly divided into two groups (n = 35, treated with methadone) and group 2 (n = 35, treated with TOP). Furthermore, patients were evaluated for withdrawal symptoms on days 1, 3, 7, 14 and 28 after treatment. Finally, the results were analyzed using SPSS 18 software.

Results: Severity of sweating (group 1: P = 0.0001, group 2: P =0. 005), runny nose (P = 0.001), lacrimation (P = 0.001), chord reflex (P = 001.0), fecal excretion (group 1: P = 0.001, group 2: P = 0.01, muscle twitches (P = 0.001), drooling (P = 0.001) warming sensation (P = 0.0001) and substance seeking (group 1: P = 0.0001, P = 0.008) in both groups were significantly improved during 28 days of treatment.

Conclusion: Methadone and TOP detoxification are both effective in opioid withdrawal syndrome and the effect of methadone and TOP in opiate withdrawal are not preferable. However, further studies are recommended.

Opium, methadone, Tincture of Opium (TOP).

Article Details

How to Cite
Jamalian, M., Nasrollahzadeh, M., Kazemifar, A. M., & Solhi, H. (2019). Comparing Methadone and Tincture of Opium for the Management of Opioid Withdrawal among Subjects with an Opioid Use Disorder. Journal of Pharmaceutical Research International, 31(6), 1-11.
Original Research Article


Botvin GJ. Griffin KW, Paul E. Preventing Tobacco and Alcohol use among elementary school students through life skills training. Journal of Child & Adolescent Substance Abuse. 2003;11(5): 290-299.

Sadock BJ, Sadock VA, Ruiz P. Comprehensive textbook of psychiatry 9th ed. Philadelphia lippincott Williams Wilkins. 2009;11(5):1367-8.

Bagheri Yazdi A, Shams Alizadeh N, Abedin A, Vazirian M. Guidelines for the Prevention and treatment of substance abuse (Especially Doctors). Salman Publishing. 2005;23(12):77-102.

Ekhtari A, Behzad A, Sadeghi M, Mirbah H. Guide to recognition and treatment of addiction in Iran. Arjomand Publications. 2002;132(24):107-95.

Rasoolian B. Opium (in addition to methadone abandonment and introducing newer drug abuse drugs). Timurzadeh Cultural Publishing Institute, Tabib Publishing. 2004;9(12):116-9.

Horspool MJ, Seivewright N, Armitage CJ, Mathers N. Post treatment ontcomes of buprenophine detoxification in community setting: A systemic Review. European addiction research. 2008;1(4):179-185.

Caplehorn JR, Bell J. Correction of error: Methadone dosage and retention of patients in maintenance treatment. Med J Aust. 1993;159(9):640-9.

Jumi Hayaki, Bradley J. Anderson b, Michael D. Stein. Drug use expectancies among no abstinent community cocaine users. Drug and Alcohol Dependence. 2009;9(4):109–115.

Dahmardehei M, Rafaiee R. Opium syrup distribution, limitation and challenges. Zahedan J Res Med Sci (ZJRMS). 2012; 14(6):48.

Solhi H, Sadeghi-Sedeh B, Emami P, Jamalian M, Kazemifar AM. Does Ingestion of Tincture of Opium Notably Raise Blood Alcohol Concentration? Addiction & Health. 2014;6(34):100- 104.

Bell J, Zador D. A risk-benefit analysis of methadone maintenance treatment. Drug Saf. 2000;22(3):179-90.

Maxwell JC, Pullum TW, Tannert K. Deaths of clients in methadone treatment in Texas: 1994-2002. Drug Alcohol Depend. 2005;78(1):73-81.

Pashaei T, Moeeni M, Roshanaei Moghdam B, Heydari H, Turner NE, Razaghi EM. Predictors of treatment retention in a major methadone maintenance treatment program in iran: A survival analysis. J Res Health Sci. 2014; 14(4):291-5.

Nosyk B, Li L, Evans E, Urada D, Huang D, Wood E, Rawson R, Hser YI. Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publicly-funded facilities in California, USA: 1991-2012. Drug Alcohol Depend. 2014;14(3):149-57.

Clausen T, Anchersen K, Waal H. Mortality prior to, during and after opioid maintenance treatment (OMT): A national prospective cross-registry study. Drug Alcohol Depend. 2008;94(1-3):151-7.

Amato L, Davoli M, Minozzi S, Ferroni E, Ali R, Ferri M. Methadone at tapered doses for the management of opioid withdrawal. Cochrane Database Syst Rev. 2013;2(21): 560-0.

Somogyi AA, Larsen M, Abadi RM, Jittiwutikarn J, Ali R, White JM. Flexible dosing of tincture of opium in the management of opioid withdrawal: Pharmacokinetics and pharmaco- dynamics. Br J Clin Pharmacol. 2008;66(5):640-7.

Gossop M, Griffiths P, Bradley B, Strang J. Opiate withdrawal symptoms in response to 10-day and 21-day methadone withdrawal programmes. The British Journal of Psychiatry. 1989;154(3):360.