title: The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone.
abstract: BACKGROUND
  Evidence suggests that the cannabinoid system is involved in the maintenance of opioid dependence. We examined whether dronabinol, a cannabinoid receptor type 1 partial agonist, reduces opioid withdrawal and increases retention in treatment with extended release naltrexone (XR-naltrexone).
  
  
  METHODS
  Opioid dependent participants were randomized to receive dronabinol 30mg/d (n=40) or placebo (n=20), under double-blind conditions, while they underwent inpatient detoxification and naltrexone induction. Before discharge all participants received an injection of XR-naltrexone, with an additional dose given four weeks later. Dronabinol or placebo was given while inpatient and for 5 weeks afterwards. The primary outcomes were the severity of opioid withdrawal, measured with the Subjective Opioid Withdrawal Scale, and retention in treatment at the end of the inpatient phase and at the end of the 8-week trial.
  
  
  RESULTS
  The severity of opioid withdrawal during inpatient phase was lower in the dronabinol group relative to placebo group (p=0.006). Rates of successful induction onto XR-naltrexone (dronabinol 66%, placebo 55%) and completion of treatment (dronabinol 35%, placebo 35%) were not significantly different. Post hoc analysis showed that the 32% of participants who smoked marijuana regularly during the outpatient phase had significantly lower ratings of insomnia and anxiety and were more likely to complete the 8-week trial.
  
  
  CONCLUSIONS
  Dronabinol reduced the severity of opiate withdrawal during acute detoxification but had no effect on rates of XR-naltrexone treatment induction and retention. Participants who elected to smoke marijuana during the trial were more likely to complete treatment regardless of treatment group assignment.
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: amb107@columbia.edu.
authors.forename: Adam
authors.initials: A
authors.lastname: Bisaga
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: sulliva@nyspi.columbia.edu.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Sullivan
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: glassan@nyspi.columbia.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Glass
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: mishlen@nyspi.columbia.edu.
authors.forename: Kaitlyn
authors.initials: K
authors.lastname: Mishlen
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: mp2370@columbia.edu.
authors.forename: Martina
authors.initials: M
authors.lastname: Pavlicova
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: haneyme@nyspi.columbia.edu.
authors.forename: Margaret
authors.initials: M
authors.lastname: Haney
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: rabywil@nyspi.columbia.edu.
authors.forename: Wilfrid N
authors.initials: WN
authors.lastname: Raby
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: levinfr@nyspi.columbia.edu.
authors.forename: Frances R
authors.initials: FR
authors.lastname: Levin
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: carpent@nyspi.columbia.edu.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Carpenter
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: mariani@nyspi.columbia.edu.
authors.forename: John J
authors.initials: JJ
authors.lastname: Mariani
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: nunesed@nyspi.columbia.edu.
authors.forename: Edward V
authors.initials: EV
authors.lastname: Nunes
mesh_terms: D000328:Adult; D002186:Cannabinoids / Q000627:therapeutic use; D003692:Delayed-Action Preparations / Q000627:therapeutic use*; D004311:Double-Blind Method; D013759:Dronabinol / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000008:administration & dosage* / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010349:Patient Compliance; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D002186:Cannabinoids; D003692:Delayed-Action Preparations; D009292:Narcotic Antagonists; D009271:Naltrexone; D013759:Dronabinol
keywords: Cannabinoid; Dronabinol; Naltrexone; Opiate dependence; Pharmacotherapy trials; Randomized Trial; Treatment