Withdrawal severity and early response to treatment in the outpatient transition from opioid use to extended release naltrexone.
Abstract
BACKGROUND AND OBJECTIVES:Long acting naltrexone has improved the therapy of opioid
use disorder (OUD), and safe and effective withdrawal management during naltrexone
induction may help advance treatment. Despite the uncertain role of opioid withdrawal
in predicting successful outcomes, early symptom control may favor detoxification
completion. METHODS:We explored withdrawal severity and early response to treatment,
safety, and clinical measures in 35 adult patients with DSM-5 OUD during a 7-day office-based
buprenorphine-naltrexone and ancillary medications transition to extended-release
naltrexone (XR-NTX). RESULTS:Subjective and objective measures of withdrawal intensity
improved consistently throughout treatment in the whole sample. Participants who went
on to receive XR-NTX (n = 27, 77%) reported a greater attenuation of symptoms by treatment
day 2 (r = .595, p = .001), and were less likely to be injection drug users (r = -.501,
p = .004). Adverse events (AEs) were recorded in 20% of participants: the majority
(n = 6, 85.7%) consisted of single episodes of increased withdrawal which were well
controlled using ancillary medications. One serious AE was unrelated to treatment.
CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE:Early opioid withdrawal changes may be a useful
indicator of treatment response, helping adjust the transition protocol to the individual
patients' need and gather valuable information for a better understanding of the relationship
between initiating and remaining in treatment. (Am J Addict 2018;27:471-476).
Type
Journal articleSubject
HumansOpioid-Related Disorders
Substance Withdrawal Syndrome
Buprenorphine
Naltrexone
Narcotic Antagonists
Delayed-Action Preparations
Drug Monitoring
Severity of Illness Index
Dose-Response Relationship, Drug
Adult
Middle Aged
Outpatients
Outcome Assessment (Health Care)
Female
Male
Symptom Assessment
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https://hdl.handle.net/10161/19929Published Version (Please cite this version)
10.1111/ajad.12763Publication Info
Mannelli, Paolo; Swartz, Marvin; & Wu, Li-Tzy (2018). Withdrawal severity and early response to treatment in the outpatient transition from
opioid use to extended release naltrexone. The American journal on addictions, 27(6). pp. 471-476. 10.1111/ajad.12763. Retrieved from https://hdl.handle.net/10161/19929.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
Marvin Stanley Swartz
Professor of Psychiatry and Behavioral Sciences
My major research interest is in examining the effectiveness of services for severely
mentally ill individuals, including factors that improve or impede good outcomes.
Current research includes: the effectiveness of involuntary outpatient commitment,
psychiatric advance directives, criminal justice outcomes for persons with mental
illnesses, violence and mental illness and antipsychotic medications. I also served
as member of the MacArthur Foundation Research Network on Mandate
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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