Fentanyl versus Methadone in Management of WithdrawalSyndrome in Opioid Addicted Patients; a Pilot ClinicalTrial

The most effective treatment for withdrawal syndrome in Opioid-dependent patients admitted tointensive care units (ICUs) remains unknown. This study aimed to compare fentanyl and methadone in this re-gard.

This prospective, single-blinded, controlled pilot study was conducted on opioid-dependent in-tubated patients admitted to the toxicology ICU of Loghman Hakim Hospital, Tehran, Iran, between August 2019and August 2020. Patients were alternately assigned to either fentanyl or methadone group after the initiation oftheir withdrawal syndrome. Duration and alleviation of the withdrawal signs and symptoms, ICU and hospitalstay, development of complications, development of later signs/symptoms of withdrawal syndrome, and needfor further administration of sedatives to treat agitation were then compared between these two groups.

Median age of the patients was 42 [interquartile range (IQR): 26, 56]. The two groups were similar in terms ofthe patients’ age (p = 0.92), sex (p = 0.632), primary Simplified Acute Physiology Score (SAPS) II (p = 0.861), andClinical Opiate Withdrawal Score (COWS) before (p = 0.537) and 120 minutes after treatment (p = 0.136) witheither methadone or fentanyl. The duration of intubation (p = 0.120), and ICU stay (p = 0.572), were also similarbetween the two groups. The only factor that was significantly different between the two groups was the timeneeded for alleviation of the withdrawal signs and symptoms after the administration of the medication, whichwas significantly shorter in the methadone group (30 vs. 120 minutes, p = 0.007).

It seems thatmethadone treats the withdrawal signs and symptoms faster in dependent patients. However, these drugs aresimilarly powerful in controlling the withdrawal signs in these patients.