Pharmacological enhancement of naltrexone treatment for opioid dependence: a review.
Abstract
PURPOSE: Opioid dependence (OD) is a serious and growing clinical condition with increasing
social costs that requires expanding treatment beyond opioid agonist substitution.
The opioid antagonist naltrexone has displayed a remarkable association of theoretical
effectiveness and poor clinical utility in treating OD due to noncompliant behavior
and low acceptability among patients, only partly modified by psychosocial interventions.
We reviewed pharmacological studies, including naltrexone depot formulations and combination
treatments. METHOD: We searched PubMed for clinical studies on the use of naltrexone
implants and slow-release injections in OD, and investigations using adjunct medications
to improve naltrexone maintenance therapy of OD. We discussed the results in view
of their application to the clinical practice. RESULTS: Significant reduction in opioid
use and improved retention in treatment have been found in several studies using depot
naltrexone formulations, some of which are controlled clinical trials. Pilot investigations
have gathered initial positive results on the use of naltrexone in combination with
serotonin reuptake inhibitors, α-2 adrenergic, opioid, and γ-aminobutyric acid agonist
medications. CONCLUSION: Current evidence suggests that more research on effectiveness
and safety is needed in support of depot naltrexone treatment for OD. Further research
comparing slow-release with oral naltrexone and opioid agonist medications will help
characterize the role of opioid antagonist-mediated treatment of OD. Preliminary investigations
on naltrexone combination treatments suggest the opportunity to continue study of
new mixed receptor activities for the treatment of OD and other drug addictions.
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https://hdl.handle.net/10161/12091Published Version (Please cite this version)
10.2147/SAR.S15853Publication Info
Mannelli, Paolo; Peindl, Kathleen S; & Wu, Li-Tzy (2011). Pharmacological enhancement of naltrexone treatment for opioid dependence: a review.
Subst Abuse Rehabil, 2011(2). pp. 113-123. 10.2147/SAR.S15853. Retrieved from https://hdl.handle.net/10161/12091.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Paolo Mannelli
Associate Professor of Psychiatry and Behavioral Sciences
Li-Tzy Wu
Professor in Psychiatry and Behavioral Sciences
Education/Training: Pre- and post-doctoral training in mental health service research,
psychiatric epidemiology (NIMH T32), and addiction epidemiology (NIDA T32) from Johns
Hopkins University School of Public Health (Maryland); Fellow of the NIH Summer Institute
on the Design and Conduct of Randomized Clinical Trials.Director: Duke Community Based
Substance Use Disorder Research Program.Research interests: COVID-19, Opioid misuse,
Opioid overdose, Opioid use disorder
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