Effectiveness of low-dose naltrexone in the post-detoxification treatment of opioid dependence.
Abstract
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.
Type
Journal articleSubject
HumansOpioid-Related Disorders
Substance Withdrawal Syndrome
Naltrexone
Clonidine
Adrenergic alpha-Agonists
Narcotic Antagonists
Drug Therapy, Combination
Analysis of Variance
Follow-Up Studies
Patient Compliance
Treatment Refusal
Psychotherapy
Adult
Female
Male
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https://hdl.handle.net/10161/20043Published Version (Please cite this version)
10.1097/jcp.0b013e31814e5e9dPublication Info
Mannelli, 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.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
Professor of Psychiatry and Behavioral Sciences
Ashwin Anand Patkar
Professor of Psychiatry and Behavioral Sciences
Kathleen S. Peindl
Assistant Consulting Professor in the Department 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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