Effectiveness of low-dose naltrexone in the post-detoxification treatment of opioid dependence.
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BACKGROUND: The clinical use of naltrexone (NTX) in the treatment of opioid dependence has been limited because of poor compliance and inconsistent outcomes. In particular, the therapeutic benefit of extended treatment with NTX after opioid detoxification is unclear. The present study evaluated whether the augmentation with low-dose NTX during the post-detoxification treatment of opioid dependence would improve outcomes. METHODS: In an open-label naturalistic design, 435 opioid-dependent patients who had completed inpatient detoxification were offered the choice of entering 1 of the 2 outpatient treatment arms: clonidine extended treatment (CET) (clonidine + psychosocial treatment), or enhanced extended treatment (EET) (oral NTX [1-10 mg/d] + CET) for 21 days. The primary outcome measure was retention in treatment. Secondary outcomes included abstinence from opioids, dropouts, and adherence to postdischarge care. RESULTS: One hundred sixty-two patients (37.2%) accepted EET. Subjects receiving EET stayed longer in the program (F = 64.4; P = 0.000), were less likely to drop out, used less opioids, and followed through with referral to long-term outpatient treatment in a higher number, compared with patients in the CET arm (P = 0.000 in each case). The NTX + clonidine combination was safe and well tolerated. CONCLUSIONS: This preliminary study indicates the potential benefit of augmentation with low-dose NTX to improve outcomes after opioid detoxification for a preferred group of patients. Randomized controlled trials are necessary to further evaluate the role of low-dose NTX in the outpatient treatment of opioid dependence.
Substance Withdrawal Syndrome
Drug Therapy, Combination
Analysis of Variance
Published Version (Please cite this version)10.1097/jcp.0b013e31814e5e9d
Publication InfoMannelli, Paolo; Patkar, Ashwin A; Peindl, Kathleen; Murray, Heather W; Wu, Li-Tzy; & Hubbard, Robert (2007). Effectiveness of low-dose naltrexone in the post-detoxification treatment of opioid dependence. Journal of clinical psychopharmacology, 27(5). pp. 468-474. 10.1097/jcp.0b013e31814e5e9d. Retrieved from https://hdl.handle.net/10161/20043.
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Associate Professor of Psychiatry and Behavioral Sciences
Professor of Psychiatry and Behavioral Sciences
Assistant Consulting Professor in the Department of Psychiatry and Behavioral Sciences
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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