Naltrexone treatment — the problem of patient acceptance

Fram, David H.

doi:10.1016/0740-5472(89)90039-1

Cited by 50 publications

(30 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given that the primary difficulty associated with naltrexone maintenance in opioid abusers is medication compliance (Kosten and Kleber 1984;Fram et al 1989;Preston et al 1999), a formulation of naltrexone that requires only once-a-month administration has important and exciting treatment implications. Future studies in our laboratory will evaluate the clinical utility of depot naltrexone in the treatment of heroin dependence.…”

Section: Discussionmentioning

confidence: 99%

Depot naltrexone: long-lasting antagonism of the effects of heroin in humans

et al. 2002

View full text Add to dashboard Cite

Rationale-Naltrexone, an opioid antagonist, is currently approved as a treatment for heroin dependence. However, naltrexone is generally not well accepted by patients, and medication noncompliance is a difficult obstacle to treatment. A sustained-release form of naltrexone may improve compliance.Objective-The present study was designed to evaluate the time course, safety, and effectiveness of a depot formulation of naltrexone (Depotrex ® ).Methods-Twelve heroin-dependent individuals participated in an 8-week inpatient study. After a 1-week detoxification period, six participants received 192 mg naltrexone base and six participants received 384 mg naltrexone base. For safety, the low dose of depot naltrexone was NIH Public AccessAuthor Manuscript Psychopharmacology (Berl). Author manuscript; available in PMC 2014 July 02. NIH-PA Author Manuscript tested before the high dose. The effects of heroin (0, 6.25, 12.5, 18.75, 25 mg, IV) were evaluated for the next 6 weeks. One dose of heroin was tested per day on Mondays through Fridays, and the entire dose range was tested each week. Active heroin doses were administered in ascending order during the week, while placebo could be administered on any day. Subjective, performance, and physiological effects were measured both before and after heroin administration. The hypotheses were that depot naltrexone would antagonize the effects of heroin, and that the high dose of depot naltrexone would produce a more effective and longer-lasting antagonism than the low dose.Results-The low and high doses of depot naltrexone antagonized heroin-induced subjective ratings for 3 and 5 weeks, respectively. Plasma levels of naltrexone remained above 1 ng/ml for approximately 3 and 4 weeks after administration of 192 mg and 384 mg naltrexone. Other than the initial discomfort associated with the injection of depot naltrexone, there were no untoward side-effects. Conclusions: These results suggest that this depot formulation of naltrexone provides a safe, effective, long-lasting antagonism of the effects of heroin.

show abstract

Section: Discussionmentioning

confidence: 99%

Depot naltrexone: long-lasting antagonism of the effects of heroin in humans

et al. 2002

View full text Add to dashboard Cite

show abstract

“…Studies on oral naltrexone treatment in criminal justice settings have shown re-duced heroin use and crime [14][15][16] . In spite of these promising results, an important limitation of oral naltrexone treatment in community settings has involved high treatment attrition and low medication compliance rates [17,18] .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

View full text Add to dashboard Cite

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.

show abstract

“…These characteristics also constitute a challenge when attempting to use naltrexone in clinical treatment. Naltrexone studies tend to have long recruitment times, suggesting that only a subgroup of the opioid-using population volunteer for naltrexone-assisted abstinence (Fram et al 1989;Bell et al 1999;Tucker, Ritter et al 2005). More importantly, engagement in naltrexone treatment tends to falter the more often patients are presented with an opportunity to miss their naltrexone dosage and relapse to heroin (Greenstein et al 1997).…”

Section: Resultsmentioning

confidence: 99%