Injectable, sustained-release naltrexone for the treatment of opioid dependence: a randomized, placebo-controlled trial.
BACKGROUND
Oral naltrexone can completely antagonize the effects produced by opioid agonists. However, poor compliance with naltrexone has been a major obstacle to the effective treatment of opioid dependence.


OBJECTIVE
To evaluate the safety and efficacy of a sustained-release depot formulation of naltrexone in treating opioid dependence.


METHODS
Randomized, double-blind, placebo-controlled, 8-week trial conducted at 2 medical centers.


METHODS
Sixty heroin-dependent adults.


METHODS
Participants were stratified by sex and years of heroin use (> or = 5 vs < 5) and then were randomized to receive placebo or 192 or 384 mg of depot naltrexone. Doses were administered at the beginning of weeks 1 and 5. All participants received twice-weekly relapse prevention therapy, provided observed urine samples, and completed other assessments at each visit.


METHODS
Retention in treatment and percentage of opioid-negative urine samples.


RESULTS
Retention in treatment was dose related, with 39%, 60%, and 68% of patients in the placebo, 192 mg of naltrexone, and 384 mg of naltrexone groups, respectively, remaining in treatment at the end of 2 months. Time to dropout had a significant main effect of dose, with mean time to dropout of 27, 36, and 48 days for the placebo, 192 mg of naltrexone, and 384 mg of naltrexone groups, respectively. The percentage of urine samples negative for opioids, methadone, cocaine, benzodiazepines, and amphetamine varied significantly as a function of dose. When the data were recalculated without the assumption that missing urine samples were positive, a main effect of group was not found for any drugs tested except cocaine, where the percentage of cocaine-negative urine samples was lower in the placebo group. Adverse events were minimal and generally mild. This formulation of naltrexone was well tolerated and produced a robust, dose-related increase in treatment retention.


CONCLUSIONS
These data provide new evidence of the feasibility, efficacy, and tolerability of long-lasting antagonist treatments for opioid dependence.
Comer
Sandra D
SD
Division on Substance Abuse, New York State Psychiatric Institute, and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York 10032, USA. sdc10@columbia.edu
Sullivan
Maria A
MA
Yu
Elmer
E
Rothenberg
Jami L
JL
Kleber
Herbert D
HD
Kampman
Kyle
K
Dackis
Charles
C
O'Brien
Charles P
CP
D000293:Adolescent; D000328:Adult; D003042:Cocaine / Q000652:urine; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006556:Heroin Dependence / Q000523:psychology / Q000534:rehabilitation* / Q000652:urine; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008691:Methadone / Q000652:urine; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage / Q000627:therapeutic use*; D009294:Narcotics / Q000652:urine; D010919:Placebos; D055502:Secondary Prevention; D015813:Substance Abuse Detection; D016896:Treatment Outcome
D003692:Delayed-Action Preparations; D009294:Narcotics; D010919:Placebos; D009271:Naltrexone; D003042:Cocaine; D008691:Methadone