Effectiveness of low-dose naltrexone in the post-detoxification treatment of opioid dependence.
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.
Mannelli
Paolo
P
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA. Paolo.Mannelli@duke.edu
Patkar
Ashwin A
AA
Peindl
Kathleen
K
Murray
Heather W
HW
Wu
Li-Tzy
LT
Hubbard
Robert
R
D000316:Adrenergic alpha-Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000704:Analysis of Variance; D003000:Clonidine / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000009:adverse effects / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010349:Patient Compliance; D011613:Psychotherapy; D013375:Substance Withdrawal Syndrome; D016312:Treatment Refusal
D000316:Adrenergic alpha-Agonists; D009292:Narcotic Antagonists; D009271:Naltrexone; D003000:Clonidine