Improving Clinical Outcomes in Treating Heroin Dependence

Hulse, Gary Kenneth; Morris, Noella; Arnold-Reed, Diane; Tait, Robert J.

doi:10.1001/archgenpsychiatry.2009.130

Cited by 113 publications

(38 citation statements)

References 30 publications

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“…Poor adherence to daily oral medication spurred the development of extended‐release injectable and implantable formulations that would eliminate the need for daily decisions to take a medication 53, 63, 64, 65, 66, 67…”

Section: Historical Perspective On Clinical Management Of Opioid Withmentioning

confidence: 99%

“…Up to one third of patients who receive XR‐NTX use illicit opioids at some point during treatment, commonly as single episodes to “test” the blocking effect of the medication 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 62. A recent study of patients using opioids during XR‐NTX blockade found that most did not feel euphoria and used lower doses than before receiving XR‐NTX.…”

Section: Current Approach To Treatment Of Opioid Use Disorder: Choosimentioning

confidence: 99%

“…A secondary analysis of the pivotal study that led to FDA approval of XR‐NTX for opioid dependence65 did not reveal any baseline patient characteristics associated with treatment outcome,105 although particularly severe, unstable psychosocial conditions may interfere with retention 106. Because most trials have been conducted in adults, limited information is available on adolescents and young adults 107, 108.…”

Section: Current Approach To Treatment Of Opioid Use Disorder: Choosimentioning

confidence: 99%

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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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Section: Historical Perspective On Clinical Management Of Opioid Withmentioning

confidence: 99%

Section: Current Approach To Treatment Of Opioid Use Disorder: Choosimentioning

confidence: 99%

Section: Current Approach To Treatment Of Opioid Use Disorder: Choosimentioning

confidence: 99%

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

et al. 2018

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“…Hulse et al 6 randomised 70 patients to active GMI (2.3g of NTX) and placebo NTX capsules or placebo implant and oral NTX 50mg/day. In both cases, family members were encouraged to supervise consumption of oral medication.…”

Section: Clinical Trials Of Ntx Implants and Dismentioning

confidence: 99%

Últimos desarrollos en los implantes y las inyecciones depot de naltrexona; el jovencito de la escalera se está haciendo mayor

Brewer¹,

Streel²

2010

Adicciones

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Implants and depot injections (DI) of naltrexone (NTX) have undergone considerable development since the first commercially available implants appeared in the mid-1990s. In particular, long-acting implants that can deliver relapse-preventing serum NTX levels for around six months have now been subjected to classic randomised controlled trials that have given positive and generally significant results when compared with oral NTX and placebo implants, or with standard post-detoxification care. They also provide lower serum levels that can prevent opiate overdose for several additional months and 3-year mortality rates are similar to those of methadone maintenance treatment (MMT). At least 18 months of antagonist-assisted abstinence may be desirable to normalise new, opiatefree cognitive-behavioural habits and extinguish old, maladaptive ones. We discuss ideological antagonisms between protagonists of MMT and of NTX implants, notably in Australia, but we argue that both treatments can and should co-exist. The main obstacle to the expansion of longacting implant treatment is not the lack of an evidential or theoretical base but the lack of a licensed product. NTX appears to block all opiates if serum levels are adequate and we stress its apparent lack of clinically significant hepatotoxicity. Some patients may need above-average serum levels and occasionally, habitual injectors continue to inject opiates despite experiencing no opiate effects. RESUMEN ABSTRACTLos implantes y las inyecciones depot (ID) de naltrexona (NTX) han experimentado un notable desarrollo desde que aparecieron los primeros implantes comerciales a mediados de los noventa. Específicamente los implantes de larga duración, capaces de proporcionar NTX en suero con niveles capaces de prevenir las recaídas durante unos 6 meses, han sido sometidos recientemente a las clásicas pruebas con control, con resultados positivos y, generalmente, significativamente superiores a la NTX oral o implantes de placebo o tratamientos estándar post desintoxicación. Además proporcionan niveles en sangre suficientes durante varios meses más para prevenir sobredosis por opiáceos. Por otro lado los índices de mortalidad a tres años son similares a los que están en programas de mantenimiento con metadona (PMM). Por lo menos serán necesarios 18 meses de abstinencia con el apoyo de antagonistas para normalizar los nuevos hábitos de comportamiento sin opiáceos y extinguir los viejos hábitos perjudiciales. Se discuten los antagonismos ideológicos que se dan, sobre todo en Australia, entre los protagonistas de PMM y los de implantes de NTX, concluyendo que ambos tipos pueden y deben coexistir. El principal obstáculo para la expansión de los tratamientos con implantes de larga duración no sería pues la falta de evidencia o de base teórica, sino la inexistencia de un fármaco con licencia. NTX parece que bloquea todos los opiáceos si sus niveles en suero son los adecuados; por otro lado debemos tener en cuenta su aparente falta de hepatotoxicidad. Algunos pacientes pueden necesita...

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“…An injectable extended-release preparation (XRNTX, Vivitrol ® ; Alkermes plc, Dublin, Ireland) gradually releases naltrexone from polymer microspheres and produces stable therapeutic levels that are pharmacologically effective for approximately one month (Krupitsky & Blokhina, 2010). Therapeutic advantages of the monthly injectable XRNTX over the daily oral preparation are stable plasma levels, greatly improved compliance profile (Hulse, Morris, Arnold-Reed, & Tait, 2009) (P. Lobmaier, Kornor, Kunoe, & Bjorndal, 2008; P.…”

Section: Introductionmentioning

confidence: 99%

Sustained opioid antagonism modulates striatal sensitivity to baby schema in opioid use disorder

Wang

Lowen

Elman

et al. 2018

Journal of Substance Abuse Treatment

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Background Chronic opioid misuse is associated with reduced sensitivity to natural rewards and social motivation deficits that include impaired caregiving. The neurobiological mechanisms underlying these deficits and their response to treatment are not well understood. Baby schema (Kindchenschema) is a set of juvenile physical features, which is perceived as “cute” and triggers motivation for caregiving. Recent studies suggest that the “baby schema effect” is mediated by the brain “reward” network. We studied the impact of opioid antagonist treatment on the baby schema response in patients with opioid use disorder. Methods Forty-seven (24 F) recently detoxified patients with opioid use disorder underwent functional magnetic resonance imaging (fMRI) while viewing infant portraits that were parametrically manipulated for baby schema content and rating them for cuteness, at baseline and during treatment with the injectable extended release opioid antagonist naltrexone (XRNTX). The study was not placebo-controlled. Results The behavioral effect of baby schema, indexed by “cuteness” ratings, was present and unaffected by XRNTX. The brain response to baby schema was absent at baseline, but present in the bilateral ventral striatum after two weeks of XRNTX treatment. The decline in self-reported craving for opioids was positively correlated with the brain fMRI response to baby schema in the bilateral ventral striatum. Conclusions Opioid antagonist treatment modulated the brain reward system response to a marker of caregiving motivation in patients with opioid use disorder. Neural response to baby schema may offer a novel probe of social motivation and affiliative behaviors in this population.

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Improving Clinical Outcomes in Treating Heroin Dependence

Abstract: The naltrexone implant effectively reduced relapse to regular heroin use compared with oral naltrexone and was not associated with major adverse events. Clinical Trial Registration anzctr.org.au Identifier: ACTRN12606000308594.

Cited by 113 publications

References 30 publications

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

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

Últimos desarrollos en los implantes y las inyecciones depot de naltrexona; el jovencito de la escalera se está haciendo mayor

Sustained opioid antagonism modulates striatal sensitivity to baby schema in opioid use disorder

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