Problem drinking and low-dose naltrexone-assisted opioid detoxification.
Abstract
OBJECTIVE:The influence of alcohol use on opioid dependence is a major problem that
warrants a search for more effective treatment strategies. The addition of very-low-dose
naltrexone (VLNTX) to methadone taper was recently associated with reduced withdrawal
intensity during detoxification. In a secondary analysis of these data, we sought
to determine whether problem drinking affects detoxification outcomes and whether
symptoms are influenced by VLNTX use. METHOD:Opioid-dependent patients (N = 174) received
naltrexone (0.125 or 0.250 mg/day) or placebo in a double-blind, randomized design
during methadone-based, 6-day inpatient detoxification. Alcohol consumption was assessed
at admission using the Addiction Severity Index and selfreport. Outcome measures were
opioid withdrawal intensity, craving, and retention in treatment. RESULTS:Problem
drinking-opioid dependent patients (n = 79) showed episodic heavy alcohol use and
reported increased subjective opioid withdrawal intensity (p = .001), craving (p =
.001), and significantly lower rate of retention in treatment (p = .02). Individuals
with problem drinking and opioid dependence who were treated with VLNTX (n = 55) showed
reduced withdrawal (p = .05) and a lower rate of treatment discontinuation (p = .03),
resuming alcohol intake in smaller numbers the day following discharge (p = .03).
Treatment effects were more pronounced on anxiety, perspiration, shakiness, nausea,
stomach cramps, and craving. There were no group differences in use of adjuvant medications
and no treatment-related adverse events. CONCLUSIONS:Heavy drinking is associated
with worse opioid detoxification outcomes. The addition of VLNTX is safe and is associated
with reduced withdrawal symptoms and better completion rate in these patients. Further
studies should explore the use of VLNTX in detoxification and long-term treatment
of combined alcohol-opioid dependence and alcohol dependence alone.
Type
Journal articleSubject
HumansOpioid-Related Disorders
Substance Withdrawal Syndrome
Methadone
Naltrexone
Narcotic Antagonists
Treatment Outcome
Severity of Illness Index
Follow-Up Studies
Double-Blind Method
Alcohol Drinking
Adult
Female
Male
Young Adult
Opiate Substitution Treatment
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https://hdl.handle.net/10161/20047Published Version (Please cite this version)
10.15288/jsad.2011.72.507Publication Info
Mannelli, Paolo; Peindl, Kathleen; Patkar, Ashwin A; Wu, Li-Tzy; Tharwani, Haresh
M; & Gorelick, David A (2011). Problem drinking and low-dose naltrexone-assisted opioid detoxification. Journal of studies on alcohol and drugs, 72(3). pp. 507-513. 10.15288/jsad.2011.72.507. Retrieved from https://hdl.handle.net/10161/20047.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
Haresh M. Tharwani
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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