Oral naltrexone maintenance treatment for opioid dependence

Abstract

The findings of this review suggest that oral naltrexone did not perform better than treatment with placebo or no pharmacological agent with respect to the number of participants re-incarcerated during the study period. If oral naltrexone is compared with other pharmacological treatments such as benzodiazepine and buprenorphine, no statistically significant difference was found. The percentage of people retained in treatment in the included studies is however low (28%). The conclusion of this review is that the studies conducted have not allowed an adequate evaluation of oral naltrexone treatment in the field of opioid dependence. Consequently, maintenance therapy with naltrexone cannot yet be considered a treatment which has been scientifically proved to be superior to other kinds of treatment.

Extended release naltrexone injection is performed in the majority of opioid dependent patients receiving outpatient induction: A very low dose naltrexone and buprenorphine open label trial

“…Naltrexone (NTX) offers a different approach but low interest and high dropout among patients that were treated with the oral formulation (Minozzi et al, 2011) led to the dismissal of NTX as a meaningful treatment in the minds of many clinicians and researchers (Adi et al, 2007; Mannelli et al, 2011). Concerns have also been expressed that NTX increases depression and anxiety and the risk for overdose death (Miotto et al, 1997; Ritter, 2002), however data from studies of oral and extended release naltrexone have shown that depression and anxiety actually decrease in patients that continue NTX (Krupitsky et al, 2012, 2004, 2006) and that there is no apparent increased risk of overdose death after treatment ends (Woody and Metzger, 2011).…”

Effectiveness of Prison-based Drug Treatment Programs: A Systematic Review of Meta-analyses

“…(e) The original evaluation studies must have the following method characteristics: there must be at least one control or comparison group; the control group should be exposed to either no intervention or minimal treatment, and the control group must not include dropouts (people who had previously participated in the treatment program but later left it). Some systematic reviews which did not meet one or more of these criteria could not be included in this study (e.g., Adams, Leukefeld, & Peden, 2008;Bright & Martire, 2013;Egli, Pina, Skovbo Christensen, Aebi, & Killias, 2009;Ferri, Davoli, & Perucci, 2011;Fiestas & Ponce, 2012;Hedrich et al, 2011;Holloway, Bennett, & Farrington, 2005Koehler, Humphreys, Akoensi, Sanchez de Ribera, & Lösel, 2014;Larney, 2010;Mazerolle, Soole, & Rombouts, 2007;McMurran, 2006;Minozzi et al, 2011;Mitchell, Wilson, Eggers, & MacKenzie, 2012;Perry, 2006;Perry, Darwin, et al, 2009;Perry et al, 2013;Perry et al, 2015aPerry et al, , 2015bPerry, Newman, et al, 2009;Tripodi, Bledsoe, Kim, & Bender, 2011;Smedslund et al, 2011;Smith, Gates, & Foxcroft, 2006;Stallwitz & Stöver, 2007).…”

Sustained release oral morphine as an alternative to methadone for the treatment of opioid-use disorder post Torsades de Pointes cardiac arrest

“…1 2 Currently, in most settings, approved pharmacotherapy includes methadone and buprenorphine/naloxone, both opioid agonists, and, in some settings, naltrexone, an opioid antagonist. 3 Methadone, in particular, has been shown to reduce mortality 4 5 and to reduce many of the health and social complications associated with opioid addiction through comparatively high treatment retention, and improved reduction in the use of illicit opioids. 6 7 When prescribed according to guidelines, methadone has a relatively safe side effect profile.…”

“…[14][15][16] Similarly, oral naltrexone has only been found to be effective when adherence is forced. 3 Thus, treating individuals who have a prolonged QTc and opioid-use disorder and who are seeking treatment can be particularly challenging. The previous literature has supported the use of an implantable cardiac defibrillator (ICD) while continuing methadone, 17 18 though avoidance of an arrhythmia would be preferable.…”