کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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6228964 | 1276582 | 2010 | 7 صفحه PDF | دانلود رایگان |
BackgroundOral naltrexone effectively antagonizes heroin, but patient noncompliance limits its utility; sustained-release preparations may overcome this. Few data are available on optimal blood naltrexone levels for preventing craving and/or return to heroin use. This study assesses various risk factors, including blood naltrexone level, for heroin craving and relapse to illicit opioids.MethodsHeroin-dependent persons from a randomized controlled trial of oral versus implant naltrexone were followed up for 6 months. Thirty-four participants received 50 mg oral naltrexone daily, plus placebo implant; thirty-five participants received a single dose of 2.3 g naltrexone implant, plus daily oral placebo tablets.ResultsCompared to oral naltrexone patients, implant naltrexone patients were significantly less likely to use any opioids and had one-fifth the risk of using heroin ⥠weekly. Risk of ⥠weekly heroin use increased by 2.5 times at blood naltrexone concentration < .5 ng/mL compared with ⥠.5 ng/mL, with 3 ng/mL associated with very low risk of use. Craving remained near “floor” levels for implant patients but rebounded to higher levels among oral patients. Lower craving scores (⤠20/70) predicted lower relapse risk. Noncompliance with daily oral formula, higher baseline craving, longer history of use, and being younger predicted higher craving at follow-up.ConclusionsImplant naltrexone was better associated with reduced heroin craving and relapse than oral naltrexone. Effective treatment was achieved at blood naltrexone levels of 1 ng/mL to 3 ng/mL, with higher levels associated with greater efficacy. Craving assessment may be valuable in predicting relapse risk allowing timely intervention.
Journal: Biological Psychiatry - Volume 68, Issue 3, 1 August 2010, Pages 296-302