Phytotherapy to Assist Opiate Withdrawal

Townsend Letter for Doctors and Patients,  July, 2001  by Kerry Bone

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Unfortunately no well-controlled clinical trials have been conducted to assess the value of herbal treatments during or following the trauma of opiate drug withdrawal. However, it can be argued from the known properties of several plants that they could play a valuable role in alleviating the acute symptoms of withdrawal and providing ongoing support for the longer-term problems such as depression and anxiety. Some of these plants are detailed below. Because of the acuteness and severity of symptoms, high doses of herbs may be required.

In addition, recent research has provided a few leads on plants which may act as a substitution therapy, in other words a kind of "herbal methadone." However, it should be stressed that, like methadone, these treatments can be dangerous in themselves and the following discussion of their properties is provided for information only.

General Treatments

From a phytotherapeutic perspective the aims of assisting with opiate withdrawal are to support the nervous system and the general physiology. Hence the plants which are chosen are often from the categories of nervine tonics (which includes antidepressants such as St John's wort), anxiolytic herbs (such as kava), general tonics (such as ginseng) and adaptogens (such as Eleutherococcus).

Nervine Tonics

The clinical activity of St John's wort in the treatment of depression is well-documented. [1] Another useful nervine tonic is the Ayurvedic herb Bacopa monniera. In Ayurveda, Bacopa is considered a brain tonic and is sometimes used for the treatment of epilepsy and insanity. Good results were noted in cases of asthenia, nervous breakdown and run-down conditions.

Bacopa significantly reduced anxiety and improved mental performance and memory in an uncontrolled trial involving 35 patients with anxiety neurosis who underwent treatment for one month. The reduction in anxiety was significant compared to baseline values after both 2 and 4 weeks of treatment (p[less than]0.05). This was accompanied by reduction in mental fatigue, a general feeling of well-being, improved sleep and appetite and an increase in body weight. The daily dose was equivalent to 12 g of dried herb. Although not significant, urinary VMA (vanillylmandelic acid, end-product of catecholamine metabolism) and 17-hydroxycorticosteroid levels were reduced. [2,3]

Bacopa had a positive effect on concentration but not on short-term memory in a small number of volunteers tested in the mid 1960s. [4] Bacopa significantly improved IQ scores in 1013 year-old children with average intelligence over a treatment period of 9 months. [6] In an earlier trial, the efficacy of Bacopa on intellectual function in 40 children (6-8 years old) was investigated against placebo. A series of tests designed to investigate visual motor function, memory, perceptual ability and visual motor perception were undertaken. Significance values were expressed by comparing the results before treatment (baseline values) and after treatment for the two groups (herbal treatment and placebo). No direct comparison between the herbal treatment group and the placebo group was calculated. Dried herb (350 mg, three times per day) for a period of 3 months was superior to placebo in all tests. In the maze learning (visual motor function) and digit span test (immediate memory), significant improvements were observed with Bacopa treatment (p[less than]0.001 compared to baseline values) with no improvement in the placebo group. Bacopa and placebo were effective in comparison to baseline values in perceptual organization and reasoning ability in terms of reaction time (p[less than]0.001 compared to p[less than]0.01).

Anxiety

Kava has shown activity in the treatment of anxiety in several clinical trials. [6] Most clinical trials on valerian have focussed on its ability to aid sleep, however a number of clinical trials have investigated the combined use of valerian and St John's wort for the treatment of depression or anxiety. Some of these trials are outlined below. A combination of valerian root and St John's wort was shown to have equivalent benefits to the drug amitriptyline (Tryptanol) in a randomized, controlled, double-blind study. One hundred and forty-seven outpatients aged between 20 and 65 were given a daily dose of 450-900 mg of valerian and St John's wort concentrates (equivalent to 0.45-0.9 mg total hypericin) or 75-150 mg of amitriptyline over 6 weeks. Benefit was observed for 82% of patients in the herbal group compared to 77% in the amitriptyline group. The total Hamilton Depression Score was reduced from 24.2 to 8.4 after 6 weeks with herbal treatment and from 24.3 to 8.9 after the drug. Statistical analysis showed that the herbal treatment was equivalent in benefit to amitriptyline but without the high frequency of side effects caused by this drug such as dry mouth and lethargy. [7] In an earlier double-blind trial, this herbal combination demonstrated significant improvement compared to the antidepressant desipramine as assessed by physicians after 6 weeks of treatment (p=0.0004). [8]