Concurrent Substance Use and Outcome in Combined Behavioral and Naltrexone Therapy for Opiate Dependence

Church, Sarah H.; Rothenberg, Jami L.; Sullivan, Maria A.; Bornstein, Greg; Nunes, Edward V.

doi:10.1081/ada-100104511

Cited by 27 publications

(27 citation statements)

References 19 publications

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“…Participants who smoked marijuana had less difficulty with sleep and anxiety and were more likely to remain in treatment as compared to those who were not using marijuana, regardless of whether they were taking dronabinol or placebo. This finding is consistent with our earlier reports showing the beneficial effects of moderate and intermittent marijuana use on compliance with naltrexone and opioid abstinence (Church et al, 2001; Raby et al, 2009). Although none of these studies used a controlled design to assess the effect of marijuana smoking a priori, the fact that we were able to replicate the finding in three separate studies strengthens its validity.…”

Section: Discussionsupporting

confidence: 94%

“…Observational data from several independent studies, and clinical experience, suggest that patients who use marijuana following induction onto naltrexone have better retention in treatment as compared to individuals who do not use marijuana (Church et al, 2001; Raby et al, 2009). This finding suggests marijuana may help alleviate withdrawal symptoms early in the course of naltrexone treatment and points to the role of the endocannabinoid system in preventing opioid dependence relapse.…”

Section: Introductionmentioning

confidence: 99%

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The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone

Bisaga

Sullivan

Glass

et al. 2015

Drug and Alcohol Dependence

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Background Evidence suggests that the cannabinoid system is involved in the maintenance of opioid dependence. We examined whether dronabinol, a cannabinoid receptor type 1 partial agonist, reduces opioid withdrawal and increases retention in treatment with extended release naltrexone (XR-naltrexone). Methods Opioid dependent participants were randomized to receive dronabinol 30 mg/d (n=40) or placebo (n=20), under double-blind conditions, while they underwent inpatient detoxification and naltrexone induction. Before discharge all participants received an injection of XR-naltrexone, with an additional dose given four weeks later. Dronabinol or placebo was given while inpatient and for 5 weeks afterwards. The primary outcomes were the severity of opioid withdrawal, measured with the Subjective Opioid Withdrawal Scale, and retention in treatment at the end of the inpatient phase and at the end of the 8-week trial. Results The severity of opioid withdrawal during inpatient phase was lower in the dronabinol group relative to placebo group (p=0.006). Rates of successful induction onto XR-naltrexone (dronabinol 66%, placebo 55%) and completion of treatment (dronabinol 35%, placebo 35%) were not significantly different. Post-hoc analysis showed that the 32% of participants who smoked marijuana regularly during the outpatient phase had significantly lower ratings of insomnia and anxiety and were more likely to complete the 8-week trial. Conclusion Dronabinol reduced the severity of opiate withdrawal during acute detoxification but had no effect on rates of XR-naltrexone treatment induction and retention. Participants who elected to smoke marijuana during the trial were more likely to complete treatment regardless of treatment group assignment.

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone

Bisaga

Sullivan

Glass

et al. 2015

Drug and Alcohol Dependence

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“…There was, however, significantly better treatment retention among intermittent=moderate cannabis users compared to abstainers and heavy=consistent users. This is consistent with previous findings in a study of opiate dependence (6), which also suggested that moderate levels of cannabis use were associated with better outcome compared to minimal use or heavy use.…”

Section: Discussionsupporting

confidence: 92%

“…The literature on the impact of cannabis use on outcome of other substance dependencies is mixed. Some studies show a worsening of prognosis (3)(4)(5), while a few studies actually suggest no effect or favorable effects (6,7). Here, we report the impact of cannabis use during treatment on the outcome of cocaine dependent patients with ADHD.…”

Section: Introductionmentioning

confidence: 74%

Concurrent Cannabis Use During Treatment for Comorbid ADHD and Cocaine Dependence: Effects on Outcome

Aharonovich

Garawi

Bisaga

et al. 2006

The American Journal of Drug and Alcohol Abuse

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Cannabis is the most widely used illicit substance in the United States with especially high prevalence of use among those with psychiatric disorders. Few studies have examined the relationship between concurrent cannabis use and treatment outcome among patients receiving treatment for comorbid substance abuse and psychiatric disorders. This study investigated the effects of cannabis use on treatment retention and abstinence from cocaine among cocaine dependent patients with Attention Deficit Hyperactivity Disorder (ADHD). Cocaine dependent patients diagnosed with current ADHD (DSM-IV, N = 92) aged 25 to 51 participated in a randomized clinical trial of methylphenidate for treatment of ADHD and cocaine dependence in an outpatient setting. The majority of patients (69%) used cannabis during treatment. Results suggest that moderate/intermittent cannabis users had greater retention rates compared to abstainers and consistent users (p = .02). This study is the first to examine concurrent cannabis use in cocaine dependent patients diagnosed with ADHD.

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“…Most research suggests that cannabis use, despite being frequent among MMT patients, is not associated with treatment outcomes (Budney, Bickel, & Amass, 1998;Church, Rothenberg, Sullivan, Bornstein, & Nunes, 2001;Epstein & Preston, 2003;Nava, Manzato, & Lucchini, 2007). One report even suggested that cannabis use was a favorable prognostic factor for treatment retention (Ellner, 1977).…”

Section: Introductionmentioning

confidence: 99%

Variations in Cannabis Use Level and Correlates in Opiate-Users on Methadone Maintenance Treatment: A French Prospective Study

Mayet

Lions

Roux

et al. 2015

Journal of Substance Abuse Treatment

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Concurrent Substance Use and Outcome in Combined Behavioral and Naltrexone Therapy for Opiate Dependence

Cited by 27 publications

References 19 publications

The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone

The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone

Concurrent Cannabis Use During Treatment for Comorbid ADHD and Cocaine Dependence: Effects on Outcome

Variations in Cannabis Use Level and Correlates in Opiate-Users on Methadone Maintenance Treatment: A French Prospective Study

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