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Problem drinking and low-dose naltrexone-assisted opioid detoxification.

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Date
2011-05
Authors
Mannelli, Paolo
Peindl, Kathleen
Patkar, Ashwin A
Wu, Li-Tzy
Tharwani, Haresh M
Gorelick, David A
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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 article
Subject
Humans
Opioid-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
Permalink
https://hdl.handle.net/10161/20047
Published Version (Please cite this version)
10.15288/jsad.2011.72.507
Publication 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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Scholars@Duke

Mannelli

Paolo Mannelli

Professor of Psychiatry and Behavioral Sciences
Patkar

Ashwin Anand Patkar

Professor of Psychiatry and Behavioral Sciences

Kathleen S. Peindl

Assistant Consulting Professor in the Department of Psychiatry and Behavioral Sciences
Tharwani

Haresh M. Tharwani

Associate Professor of Psychiatry and Behavioral Sciences
Wu

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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