Advances in Opioid Antagonist Treatment for Opioid Addiction

Ling, Walter; Mooney, Larissa; Wu, Li‐Tzy

doi:10.1016/j.psc.2012.03.002

Cited by 13 publications

(11 citation statements)

References 36 publications

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“…environmental stimuli previously associated with opioid use) serve as triggers to resumed opioid use, may be attenuated by naltrexone . Cognition is also probably involved—if patients take opioids and experience that the effects are blocked by a medication, they may not try opioids again unless they have stopped the medication and know it has worn off . This is consistent with clinical experience wherein, rather than gradual reduction of opioid use as in extinction, patients receiving XR‐NTX often report trying just a single dose or a few doses (‘hits') of opioids, experiencing the blockade (‘I felt nothing, and knew I was wasting my money') then ceasing further use.…”

Section: Introductionmentioning

confidence: 73%

“…Extended‐release naltrexone (XR‐NTX) is a monthly injection of naltrexone approved for the prevention of relapse to opioid dependence following detoxification from opioids. Naltrexone was originally developed and fast‐tracked into clinical use in an oral formulation based on the seminal pre‐clinical work of Wikler, who proposed that an opioid antagonist would be an effective treatment for opioid use disorder based on operant conditioning theory . Operant theory would suggest that extinction takes place during treatment with XR‐NTX, as patients stop seeking opioids because episodes of opioid use are no longer reinforcing.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Opioid use and dropout from extended‐release naltrexone in a controlled trial: implications for mechanism

et al. 2019

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Background and aims Extended-release formulations of naltrexone have emerged as effective treatment options for opioid use disorder. This post-hoc analysis examined the temporal relationship between episodes of opioid use and subsequent dropout in a placebo-controlled trial of extended-release injection naltrexone (XR-NTX) to draw inferences about the mechanism by which extended blockade of opioid receptors translates into clinical effectiveness. Design This was a 24-week multiple-site, double-blind, randomized trial of monthly XR-NTX versus placebo injections. We analyzed time to dropout from treatment using survival analysis with an extended Cox model as a function of treatment (XR-NTX versus placebo) and with weekly urine drug test (UDT) results for opioids at each week as a time-dependent covariate.Setting Thirteen addiction treatment programs in Russia, 2008-09. Participants A total of 250 adults with opioid use disorder who had completed in-patient detoxification. Intervention XR-NTX injection or placebo injection every 4 weeks with weekly clinic visits and biweekly counseling. Measurements Urine toxicology for opioids measured weekly and week of dropout from treatment. Findings The Cox model yielded a significant interaction of time-dependent urine toxicology by treatment (P = 0.024). Among patients receiving placebo, a positive UDT in a given week increased the risk for dropout from treatment in the subsequent week [hazard ratio (HR) = 6.25; 95% confidence interval (CI) = 3.6-10.0], whereas among patients receiving XR-NTX, a positive UDT result showed no significant effect on risk for dropout (HR = 1.67; 95% CI = 0.6-4.5). The proportion of patients who completed all 24 weeks without any positive UDT result was 31% on XR-NTX compared with 20% on placebo (P = 0.051). Conclusions Extended-release injection naltrexone was effective at reducing the risk of dropout from opioid use disorder treatment after an episode of opioid use. Just under a third of patients (31%) on XR-NTX had no opioid-positive urine tests across the trial, but the hypothesis that this would differ from placebo (20%) was not confirmed.

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Section: Introductionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Opioid use and dropout from extended‐release naltrexone in a controlled trial: implications for mechanism

et al. 2019

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“…Past studies have also examined adoption of naltrexone in the context of alcohol use disorder and found that only 15 percent of alcohol treatment clinicians prescribe naltrexone often [ 25 ]. In light of the dearth of information regarding patient profiles that may be appropriate for XR-NTX, Ling et al outlined some of the questions regarding the role of XR-NTX in opioid dependence, including the fact that “no one seems to have figured out that perhaps we should ask our patients whether they would like to take [XR-NTX]” [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Placebo-controlled trials have demonstrated its efficacy in retaining patients in treatment, increasing abstinence, and decreasing opioid cravings [ 15 - 17 ]. However, it has recently been noted that the willingness of opioid-addicted patients to take XR-NTX has not been well described [ 18 ]. Since little is known about the willingness of opioid-addicted patients to take an extended-release, opioid-antagonist medication (or about factors that may predict willingness), we undertook this study to examine the willingness to use XR-NTX among opioid-addicted patients participating in a cohort study in Vancouver, Canada.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with willingness to take extended release naltrexone among injection drug users

Ahamad

Milloy

Nguyen

et al. 2015

Addict Sci Clin Pract

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BackgroundAlthough opioid-agonist therapy with methadone or buprenorphine/naloxone is currently the mainstay of medical treatment for opioid use disorder, these medications often are not well accepted or tolerated by patients. Recently, extended release naltrexone (XR-NTX), an opioid antagonist, has been advanced as an alternative treatment. The willingness of opioid-addicted patients to take XR-NTX has not been well described.MethodsOpioid-using persons enrolled in a community-recruited cohort in Vancouver, Canada, were asked whether or not they would be willing to take XR-NTX. Logistic regression was used to independently identify factors associated with willingness to take the medication.ResultsAmong the 657 participants surveyed between June 1, 2013, and November 30, 2013, 342 (52.1%) were willing to take XR-NTX. One factor positively associated with willingness was daily heroin injection (adjusted odds ratio [AOR] = 1.53; 95% confidence interval [CI] = 1.02–2.31), whereas Caucasian ethnicity was negatively associated (AOR = 0.59; 95% CI = 0.43–0.82). Satisfaction with agonist therapy (13.4%) and unwillingness to stop opioids being used for pain (26.9%) were the most common reasons for being unwilling to take XR-NTX.ConclusionsA high level of willingness to take XR-NTX was observed in this setting. Interestingly, daily injection heroin use was positively associated with willingness, whereas Caucasian participants were less willing to take XR-NTX. Although explanations for unwillingness were described in this study, further research is needed to investigate real-world acceptability of XR-NTX as an additional option for the treatment of opioid use disorder.

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“…Patients must also abstain from opioids seven to ten days before starting XR-NTX, a significant barrier for many opioid dependent people. 12,13 …”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Injectable Extended-Release Naltrexone Compared with Methadone Maintenance and Buprenorphine Maintenance Treatment for Opioid Dependence

et al. 2015

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Background The aim of this study was to estimate the cost-effectiveness of injectable extended release naltrexone (XR-NTX) compared to methadone maintenance and buprenorphine maintenance treatment (MMT and BMT respectively) for adult males enrolled in treatment for opioid dependence in the United States from the perspective of state-level addiction treatment payers. Methods We used a Markov model with daily time cycles to estimate the incremental cost per opioid-free day in a simulated cohort of adult males ages 18–65 over a six-month period from the state health program perspective. Results XR-NTX is predicted to be more effective and more costly than methadone or buprenorphine in our target population, with an incremental cost per opioid-free day gained relative to the next-most effective treatment (MMT) of $72. The cost-effectiveness of XR-NTX relative to MMT was driven by its effectiveness in deterring opioid use while receiving treatment. Conclusions XR-NTX is a cost-effective medication for treating opioid dependence if state addiction treatment payers are willing to pay at least $72 per opioid-free day.

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Advances in Opioid Antagonist Treatment for Opioid Addiction

Cited by 13 publications

References 36 publications

Opioid use and dropout from extended‐release naltrexone in a controlled trial: implications for mechanism

Opioid use and dropout from extended‐release naltrexone in a controlled trial: implications for mechanism

Factors associated with willingness to take extended release naltrexone among injection drug users

Cost-Effectiveness of Injectable Extended-Release Naltrexone Compared with Methadone Maintenance and Buprenorphine Maintenance Treatment for Opioid Dependence

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