What is the efficacy of extended-release naltrexone in the prevention of opioid abuse relapse?

Updated: Jun 21, 2018
  • Author: David W Dixon, DO; Chief Editor: Glen L Xiong, MD  more...
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A study of 150 opioid-dependent individuals examined the efficacy of two methods of outpatient opioid detoxification for induction to extended-release naltrexone – .naltrexone-assisted detoxification and a buprenorphine taper. The trial demonstrated that naltrexone-assisted detoxification increased the likelihood of a successful transition to extended-release injection naltrexone (XR-naltrexone) by almost threefold compared with those given a buprenorphine taper. Study findings support the development of a detoxification regimen of ascending doses of oral naltrexone for transitioning opioid-dependent patients seeking induction onto XR-naltrexone for the prevention of relapse. [51]

In a double-blind, placebo-controlled, randomized, 24-week trial, 250 patients with opiate dependence were given monthly injections of an extended-release formulation of 380 mg of naltrexone or placebo. [52] The study found substantial benefit in the actively treated group, with abstinence rates of 90% compared with 35%. Other measures confirmed this benefit, with a median retention of 168 days in the naltrexone group compared with 96 days in the placebo group, and reduced craving in the naltrexone group. Given the poor therapeutic efficacy of oral naltrexone in most opioid-dependent populations, this intramuscular formulation may be a valuable addition to the methods of treating opioid dependence if its value is verified in subsequent studies over longer therapeutic time periods in diverse groups of patients.

The use of naltrexone was shown to be effective in fostering sobriety in heroin- and amphetamine-dependent outpatients in a 10-week randomized, double-blind, placebo-controlled trial. Naltrexone implants resulted in higher retention in the study (52% of patients with naltrexone implants versus 28% in the control group), decreased heroin and amphetamine use (drug-free urine samples were 38% for the naltrexone group versus 16% placebo), and improved clinical conditions for the patients. [53]

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