Trazodone Improves Subjective Sleep Quality Among Individuals With Opioid Use Disorder Receiving Buprenorphine

Sleep disturbances are common among individuals with opioid use disorder (OUD), but many medications prescribed for sleep are associated with significant risks and side effects. Trazodone is prescribed widely at low doses to help with sleep. This 6-week placebo-controlled trial in India evaluated the effect of trazodone among 100 adult men with OUD who were receiving buprenorphine and had sleep disturbance, defined as a score of ≥6 on the Pittsburgh Sleep Quality Index (PSQI). Participants were given trazadone 50 mg or placebo tablets and told they could take up to 3 tablets one hour before bedtime.

• The primary outcome measure was a PSQI of ≤5; 82% of participants assigned to trazodone achieved this outcome, compared with 18% of those receiving placebo.
• There was no significant difference between groups in daytime sleepiness, withdrawal, craving, depression, or anxiety scores.

Comments: The standard of care for insomnia is cognitive behavioral therapy. This study found that trazodone had short-term subjective benefits for individuals with OUD receiving buprenorphine, suggesting that it is a reasonable medication to treat insomnia in this population.

Darius A. Rastegar, MD

Reference: Goyal P, Kattula D, Rao R, et al. Trazodone for sleep disturbance in opioid dependence patients maintained on buprenorphine: a double blind, placebo-controlled trial. Drug Alcohol Depend. 2023;250:110891.