Behavioral naltrexone therapy

Rothenberg, Jami L.; Sullivan, Maria A.; Church, Sarah H.; Seracini, Angela M.; Collins, Eric D.; Kleber, Herbert D.; Nunes, Edward V.

doi:10.1016/s0740-5472(02)00301-x

Cited by 73 publications

(27 citation statements)

References 37 publications

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“…14,16,20–25,32 On Day 3, participants began standing doses of clonidine (0.1–0.2 mg every 4 hours up to 1.2 mg) and clonazepam (1.0 mg every 6 hours up to 2 mg), which continued until Day 8. On Day 4, following pretreatment with prochlorperazine 10 mg, oral naltrexone was started at a dose of 1 mg, with additional doses given daily in ascending order (3 mg, 6 mg, 12 mg, 25 mg).…”

Section: Methodsmentioning

confidence: 99%

“…Safe transition from opioid agonists to naltrexone in one week has been demonstrated. 15,18–19 In earlier trials over the past two decades, 14,16,20–25 we have developed and modified a 7-day detoxification regimen combining low doses of oral naltrexone with single-day buprenorphine and standing ancillary medications. Recently, Mannelli and colleagues, building on prior animal 26 and human work 27,28 on opioid detoxification, conducted a pilot study with simultaneous administration of buprenorphine and very low doses of oral naltrexone to initiate XR-naltrexone in an outpatient setting.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-Acting Injectable Naltrexone Induction: A Randomized Trial of Outpatient Opioid Detoxification With Naltrexone Versus Buprenorphine

Sullivan

Bisaga

Pavlicová

et al. 2017

AJP

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-Acting Injectable Naltrexone Induction: A Randomized Trial of Outpatient Opioid Detoxification With Naltrexone Versus Buprenorphine

Sullivan

Bisaga

Pavlicová

et al. 2017

AJP

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“…Newer protocols focused on identifying optimal doses and treatment durations of buprenorphine, naltrexone, and clonidine to shorten induction periods, while minimizing the severity of withdrawal. Major changes to earlier protocols involved reducing buprenorphine treatment to 1–2 days, shortening to 1 day the “washout” period before starting naltrexone, and decreasing the first dose of naltrexone from 12.5 to 3 mg, with supportive medications, usually standing doses of clonidine and clonazepam administered at frequent dosing intervals 51, 52, 53, 54, 55, 56, 57. A 2017 study comparing outpatient detoxification regimens showed that an oral naltrexone‐assisted detoxification regimen, compared with a descending buprenorphine taper followed by a 7‐day washout period, was more likely to lead to successful XR‐NTX induction (56% vs. 33%) and a second XR‐NTX dose (50% vs. 27%) 58…”

Section: Historical Perspective On Clinical Management Of Opioid Withmentioning

confidence: 99%

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

et al. 2018

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Background and ObjectivesOpioid use disorder (OUD) is a chronic condition with potentially severe health and social consequences. Many who develop moderate to severe OUD will repeatedly seek treatment or interact with medical care via emergency department visits or hospitalizations. Thus, there is an urgent need to develop feasible and effective approaches to help persons with OUD achieve and maintain abstinence from opioids. Treatment that includes one of the three FDA‐approved medications is an evidence‐based strategy to manage OUD. The purpose of this review is to address practices for managing persons with moderate to severe OUD with a focus on opioid withdrawal and naltrexone‐based relapse‐prevention treatment.MethodsLiterature available on PubMed was used to review the evolution of treatment strategies from the 1960s onward to manage opioid withdrawal and initiate treatment with naltrexone.ResultsEmerging practices for extended‐release naltrexone induction include the use of agonist tapers and adjuvant medications. Clinical challenges frequently encountered when initiating this therapy include managing withdrawal and ongoing opioid use during treatment. Clinical factors may inform decisions regarding patient selection and length of naltrexone treatment, such as recent opioid use and patient preferences.Conclusions and Scientific SignificanceTreatment strategies to manage opioid withdrawal have evolved, but many patients with OUD do not receive medication for the prevention of relapse. Clinical strategies for induction onto extended‐release naltrexone are now available and can be safely and effectively implemented in specialty and select primary care settings. (© 2018 The Authors. The American Journal on Addictions Published by Wiley Periodicals, Inc. on behalf of The American Academy of Addiction Psychiatry (AAAP);27:177–187)

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“…Another strategy involves administration of a small dose of buprenorphine (i.e., 4–8 mg) approximately 16–24 h after the patient ceases opioid use and when withdrawal symptoms begin to occur, followed by administration of clonidine and other adjunctive medications (e.g., benzodiazepines, antiemetics, NSAIDS, sleep medications) (31,57). This approach is based on the rationale that buprenorphine will reduce withdrawal severity while making a transition from a full to a partial agonist.…”

Section: Detoxification With Clonidine and Other Nonopioid Medicationsmentioning

confidence: 99%

Opioid Detoxification and Naltrexone Induction Strategies: Recommendations for Clinical Practice

Sigmon

Bisaga

Nunes

et al. 2012

The American Journal of Drug and Alcohol Abuse

106

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Background Opioid dependence is a significant public health problem associated with high risk for relapse if treatment is not ongoing. While maintenance on opioid agonists (i.e., methadone, buprenorphine) often produces favorable outcomes, detoxification followed by treatment with the μ-opioid receptor antagonist naltrexone may offer a potentially useful alternative to agonist maintenance for some patients. Method Treatment approaches for making this transition are described here based on a literature review and solicitation of opinions from several expert clinicians and scientists regarding patient selection, level of care, and detoxification strategies. Conclusion Among the current detoxification regimens, the available clinical and scientific data suggest that the best approach may be using an initial 2–4 mg dose of buprenorphine combined with clonidine, other ancillary medications, and progressively increasing doses of oral naltrexone over 3–5 days up to the target dose of naltrexone. However, more research is needed to empirically validate the best approach for making this transition.

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Behavioral naltrexone therapy

Cited by 73 publications

References 37 publications

Long-Acting Injectable Naltrexone Induction: A Randomized Trial of Outpatient Opioid Detoxification With Naltrexone Versus Buprenorphine

Long-Acting Injectable Naltrexone Induction: A Randomized Trial of Outpatient Opioid Detoxification With Naltrexone Versus Buprenorphine

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

Opioid Detoxification and Naltrexone Induction Strategies: Recommendations for Clinical Practice

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