Comparative treatment and mortality correlates and adverse event profile of implant naltrexone and sublingual buprenorphine

Reece, Albert Stuart

doi:10.1016/j.jsat.2009.03.008

Cited by 9 publications

(7 citation statements)

References 70 publications

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“…Cost-effectiveness may vary depending on how effective and costly implantable naltrexone is relative to its oral formulation. A recent Australian clinical audit suggests that naltrexone-implanted patients had longer total treatment duration, more days in treatment per episode, longer mean treatment times, but fewer treatment episodes than buprenorphine [31]. Second, our findings’ generalizability may be limited since the study was conducted through community recruitment and a single outpatient clinic in Muar, Malaysia.…”

Section: Discussionmentioning

confidence: 90%

Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia

Ruger

Chawarski

Mazlan³

et al. 2012

PLoS ONE

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AimsTo aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia.DesignWe estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants’ time were estimated using Malaysia’s minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars.SettingMuar, Malaysia.Participants126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003–2005) receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence.MeasurementsPrimary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores.FindingsBuprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine.ConclusionsBuprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.

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Section: Discussionmentioning

confidence: 90%

Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia

Ruger

Chawarski

Mazlan³

et al. 2012

PLoS ONE

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“…It is further noted that no cases of cancer have been reported in either clinical trials of naltrexone implants [56,57] nor in large comparative case review series [58]. Contrariwise one notes that greatly elevated rates of malignancies affecting the bladder, oesophagus, larynx and oropharynx have been noted in patients who are exposed to long term opiate agonist treatment [59][60][61][62].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally met enkephalin has been shown to inhibit angiogenesis, boost levels of natural killer cells and potentially have an immunostimulating/immunoregulating effect [28]. Alternatively, naltrexone is thought to mediated changes to the neuroendocrine system (34,56,58), increasing the number, density and sensitivity of opiate receptors in tissue, and increasing NK cell numbers [29][30][31][32][33][34].…”

Section: Introductionmentioning

confidence: 99%

The Occurrence of Spontaneous Lymphomas but Not Adenomas or Sarcomas in Rats Treated With Sustained Release Naltrexone

Kelty¹

2012

Clin Exp Pharmacol

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Naltrexone has been observed to have both a stimulatory and inhibitory effect on the development of tumours in rodents, potentially mediated by changes to the neuroendocrine system as a result of blockade of the opiate receptors, with the period of blockade and the tumour type thought to be influential. This study examined the occurrence of spontaneous tumours in rats treated with a sustained release naltrexone preparation. Materials and methods: 27 male and 27 female rats were randomized into three equal treatment groups (A, B and C). Rats in group A were implanted with a single naltrexone implant tablet, rats in group B were implanted with a single polymer implant tablet (placebo) and rats in group C underwent a sham procedure (control). Three different groups of spontaneous tumours were observed; lymphomas, adenomas and sarcomas. Lymphomas (4 tumours/3 rats) were observed solely in naltrexone treated rats, while adenomas (9 tumours/5 rats) and sarcomas (4 tumours/3 rats) were only observed in the placebo and the control groups. The data suggests that the association of naltrexone on the development of tumours maybe dependent on tumour type. Long term exposure to naltrexone appears to have both a stimulatory and inhibitory effect on tumours in rats, dependent on tumour type.

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“…At this point, we have found results of retrospective studies in limited samples suggesting that sustained-release naltrexone can reduce drug use and drug-related hospitalizations as much as methadone treatment does,60 or more 77. Moreover, the mortality profile in samples of patients treated with naltrexone implant is comparable to that of buprenorphine or methadone, or to the normal population 23,78,79…”

Section: Sustained-release Naltrexonementioning

confidence: 96%

Pharmacological enhancement of naltrexone treatment for opioid dependence: a review

Mannelli¹,

Peindl²,

Wu³

2011

SAR

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Purpose Opioid dependence (OD) is a serious and growing clinical condition with increasing social costs that requires expanding treatment beyond opioid agonist substitution. The opioid antagonist naltrexone has displayed a remarkable association of theoretical effectiveness and poor clinical utility in treating OD due to noncompliant behavior and low acceptability among patients, only partly modified by psychosocial interventions. We reviewed pharmacological studies, including naltrexone depot formulations and combination treatments. Method We searched PubMed for clinical studies on the use of naltrexone implants and slow-release injections in OD, and investigations using adjunct medications to improve naltrexone maintenance therapy of OD. We discussed the results in view of their application to the clinical practice. Results Significant reduction in opioid use and improved retention in treatment have been found in several studies using depot naltrexone formulations, some of which are controlled clinical trials. Pilot investigations have gathered initial positive results on the use of naltrexone in combination with serotonin reuptake inhibitors, α-2 adrenergic, opioid, and γ-aminobutyric acid agonist medications. Conclusion Current evidence suggests that more research on effectiveness and safety is needed in support of depot naltrexone treatment for OD. Further research comparing slow-release with oral naltrexone and opioid agonist medications will help characterize the role of opioid antagonist-mediated treatment of OD. Preliminary investigations on naltrexone combination treatments suggest the opportunity to continue study of new mixed receptor activities for the treatment of OD and other drug addictions.

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Comparative treatment and mortality correlates and adverse event profile of implant naltrexone and sublingual buprenorphine

Cited by 9 publications

References 70 publications

Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia

Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia

The Occurrence of Spontaneous Lymphomas but Not Adenomas or Sarcomas in Rats Treated With Sustained Release Naltrexone

Pharmacological enhancement of naltrexone treatment for opioid dependence: a review

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