Naltrexone implants after in-patient treatment for opioid dependence: randomised controlled trial

Kunøe, Nikolaj; Lobmaier, Philipp; Vederhus, John‐Kåre; Hjerkinn, Bjørg; Hegstad, Solfrid; Gossop, Michael; Kristensen, Øistein; Waal, Helge

doi:10.1192/bjp.bp.108.055319

Cited by 78 publications

(69 citation statements)

References 29 publications

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“…Naltrexone depot and implant treatment has been found to lead to reduced heroin use and mortality [22][23][24] . Recently, a number of papers have reviewed the possible beneficial effects of sustained-release naltrexone for criminal justice populations [25][26][27][28] .…”

Section: Introductionmentioning

confidence: 99%

Naltrexone Implants Compared to Methadone: Outcomes Six Months after Prison Release

et al. 2010

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Background:After prison release, offenders with heroin use problems are at high risk of relapse and overdose death. There is a particular need for treatments that can be initiated in prison and continued after release into the community. Methadone maintenance treatment has been shown to reduce heroin use, criminality and mortality. Naltrexone implant treatment has not previously been evaluated in prison settings. Methods:This study compares the effects of naltrexone implants and methadone treatment on heroin and other illicit drug use, and criminality among heroin-dependent inmates after release from prison. Results:Forty-six volunteers were randomly allocated to naltrexone implants or methadone before release. Intention-to-treat analyses showed reductions in both groups in frequency of use of heroin and benzodiazepines, as well as criminality, 6 months after prison release. Conclusions:Naltrexone implants may be a valuable treatment option in prison settings.

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Section: Introductionmentioning

confidence: 99%

Naltrexone Implants Compared to Methadone: Outcomes Six Months after Prison Release

et al. 2010

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“…This has proven beneficial compared to placebo ), compared to oral naltrexone (Hulse et al 2009) and compared to 'usual treatment' controls (Kunøe et al 2009). These findings constitute support for the hypothesis that reducing the frequency of dropout opportunities is of importance in making naltrexone treatment effective in the treatment of opioid dependence.…”

Section: Resultsmentioning

confidence: 99%

“…The implantation procedure and any adverse events have been described elsewhere (Kunøe et al 2009;Lobmaier et al in press). Four to eight weeks before six-month follow-up, patients were contacted by telephone to offer a second implant and to schedule an appointment for the follow-up data collection.…”

Section: Methodsmentioning

confidence: 99%

Sustained-Release Naltrexone For Opioid Dependence

Lobmaier

Kornør

Kunøe

et al. 2008

Cochrane Database of Systematic Reviews

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“…The typical true completion rate even in 'centres of excellence' is less than 30% . 8 In contrast, on an 'intention-to-treat' (ITT) basis, 100% of patients in this study reached this vital stage of treatment Kunoe et al 9 conducted a multi-centre, open-label study of 56 patients (approximately 85% heroin injectors) aged ≥18 from various in-patient detoxification programmes in SE Norway and willing to be randomised. If detoxification was completed, they received either normal post-detox care (control) or normal care plus a GMI.…”

Section: Clinical Trials Of Ntx Implants and Dismentioning

confidence: 90%

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

Brewer¹,

Streel²

2010

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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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Naltrexone implants after in-patient treatment for opioid dependence: randomised controlled trial

Abstract: Naltrexone implant treatment safely and significantly reduces opioid use in a motivated population of patients.

Cited by 78 publications

References 29 publications

Naltrexone Implants Compared to Methadone: Outcomes Six Months after Prison Release

Naltrexone Implants Compared to Methadone: Outcomes Six Months after Prison Release

Sustained-Release Naltrexone For Opioid Dependence

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

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