Comparing Drug-Related Hospital Morbidity Following Heroin Dependence Treatment With Methadone Maintenance or Naltrexone Implantation

Ngo, Hanh; Tait, Robert J.; Hulse, Gary Kenneth

doi:10.1001/archpsyc.65.4.457

Cited by 30 publications

(38 citation statements)

References 34 publications

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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: 95%

“…Alcohol and nonopioid drug use as well as associated morbidity are significant unresolved problems in naltrexone maintenance treatment 77. Rothman and co-workers107 first proposed the combination naltrexone/buprenorphine as a functional κ-opioid receptor antagonist to help overcome dysphoric symptoms associated with prolonged opioid withdrawal discomfort and cocaine use.…”

Section: Pharmacological Combinationsmentioning

confidence: 99%

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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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Section: Sustained-release Naltrexonementioning

confidence: 95%

Section: Pharmacological Combinationsmentioning

confidence: 99%

Pharmacological enhancement of naltrexone treatment for opioid dependence: a review

Mannelli¹,

Peindl²,

Wu³

2011

SAR

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“…Opioid overdose deaths have also been reported 123. Conversely, longitudinal cohort data collected prospectively in Australia indicate an absence of mortality associated with naltrexone implant treatment 124, and further, naltrexone implantation has been associated with long-term reductions in opioid-related hospital morbidity 125. Davoli et al 126 report that overall, overdose mortality risk while in opioid treatment is significantly lower than when out of treatment, with the first month post-treatment being a considerably risky time.…”

Section: Antagonist Medications For Opioid Dependencementioning

confidence: 99%

Opioid dependence treatment: options in pharmacotherapy

Stotts

Dodrill

Kosten

2009

Expert Opinion on Pharmacotherapy

200

162

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The development of effective treatments for opioid dependence is of great importance given the devastating consequences of the disease. Pharmacotherapies for opioid addiction include opioid agonists, partial agonists, opioid antagonists, and alpha-2-adrenergic agonists, which are targeted toward either detoxification or long-term agonist maintenance. Agonist maintenance therapy is currently the recommended treatment for opioid dependence due to its superior outcomes relative to detoxification. Detoxification protocols have limited long term efficacy and patient discomfort remains a significant therapy challenge. Buprenorphine’s effectiveness relative to methadone remains a controversy and may be most appropriate for patients in need of low doses of agonist treatment. Buprenorphine appears superior to alpha-2 agonists, however, and office-based treatment with buprenorphine in the US is gaining support. Studies of sustained-release formulations of naltrexone suggest improved effectiveness for retention and sustained abstinence, however, randomized clinical trials are needed.

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“…Very few studies have been conducted concerning sustained release naltrexone in opiate abstinence. Naltrexone implants with a one-month duration have been studied in Australia where they were associated with decreased mortality and morbidity [38,39]. Despite these promising results, larger scales studies need to be conducted following reports of dehydration, opiate withdrawal syndromes and fatal overdoses [40,41].…”

Section: Pharmacotherapies In Opiate Abstinencementioning

confidence: 99%

Pharmacological Treatments of Opiate Dependence

Benyamina¹,

Reynaud²,

Blecha³

et al. 2011

CPD

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Opiate substitution therapies have largely contributed to improving outcomes in opiate dependent patients. Their impact has significantly diminished HIV transmission rates, decreased incidence of overdose and reduced delinquency due to heroin trafficking. Since then, some advances have been made in the formulations and dosing regimen of these treatments. They have also largely facilitated opiate withdrawal. However, concerning the maintenance of opiate abstinence, very few new treatments have been proposed. Despite considerable advances in our knowledge of the neurobiological mechanisms of opiate dependence, few clinical trials have been proposed to test new molecules both in accompanying opiate substitution and in maintaining abstinence from illicit opiate use. The objective of this article is to examine the evidence concerning the treatment of opiate dependent patients, especially new treatments and to examine the eventual gaps between currently knowledge, available treatment and demands.

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Comparing Drug-Related Hospital Morbidity Following Heroin Dependence Treatment With Methadone Maintenance or Naltrexone Implantation

Cited by 30 publications

References 34 publications

Pharmacological enhancement of naltrexone treatment for opioid dependence: a review

Pharmacological enhancement of naltrexone treatment for opioid dependence: a review

Opioid dependence treatment: options in pharmacotherapy

Pharmacological Treatments of Opiate Dependence

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