Limits...
Psychosocial and treatment correlates of opiate free success in a clinical review of a naltrexone implant program.

Reece AS - Subst Abuse Treat Prev Policy (2007)

Bottom Line: The Kaplan Meier 12 month OFS were 82%, 58% and 52% respectively. 12 post-treatment variables were independently associated with treatment retention.Consistent with the voluminous international literature clinically useful retention rates can be achieved with naltrexone, which may be improved by implants and particularly serial implants, repeat detoxification, meticulous clinical follow-up, and social support.As depot formulations of naltrexone become increasingly available such results can guide their clinical deployment, improve treatment outcomes, and enlarge the policy options for an exciting non-addictive pharmacotherapy for opiate addiction.

View Article: PubMed Central - HTML - PubMed

Affiliation: Southcity Family Medical Centre, University of Queensland, 39 Gladstone Rd., Highgate Hill, Brisbane, Queensland, 4101, Australia. sreece@bigpond.net.au

ABSTRACT

Background: There is on-going controversy in relation to the efficacy of naltrexone used for the treatment of heroin addiction, and the important covariates of that success. We were also interested to review our experience with two depot forms of implantable naltrexone.

Methods: A retrospective review of patients' charts was undertaken, patients were recalled by telephone and by letter, and urine drug screen samples were collected. Opiate free success (OFS) was the parameter of interest. Three groups were defined. The first two were treated in the previous 12 months and comprised "implant" and "tablet" patients. A third group was "historical" comprising those treated orally in the preceding 12 months.

Results: There were 102, 113 and 161 patients in each group respectively. Groups were matched for age, sex, and dose of heroin used, but not financial status or social support. The overall follow-up rate was 82%. The Kaplan Meier 12 month OFS were 82%, 58% and 52% respectively. 12 post-treatment variables were independently associated with treatment retention. In a Cox proportional hazard multivariate model social support, the number of detoxification episodes, post-treatment employment, the use of multiple implant episodes and spiritual belief were significantly related to OFS.

Conclusion: Consistent with the voluminous international literature clinically useful retention rates can be achieved with naltrexone, which may be improved by implants and particularly serial implants, repeat detoxification, meticulous clinical follow-up, and social support. As depot formulations of naltrexone become increasingly available such results can guide their clinical deployment, improve treatment outcomes, and enlarge the policy options for an exciting non-addictive pharmacotherapy for opiate addiction.

Show MeSH

Related in: MedlinePlus

Opiate Free Success by: A.: Combined Oral Tablet and Implant Group; B: Perth, USA, Tablet and Historical Groups. C.: Presence or Absence of Urinary Naltrexone. **** – P < 0.0001; ** – P < 0.025.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2211472&req=5

Figure 1: Opiate Free Success by: A.: Combined Oral Tablet and Implant Group; B: Perth, USA, Tablet and Historical Groups. C.: Presence or Absence of Urinary Naltrexone. **** – P < 0.0001; ** – P < 0.025.

Mentions: Figure 1 shows the proportion of patients complying with treatment by the various treatment groups. Figure 1A shows the outcome by the three treatment groups. Figure 1B illustrates the respective outcomes by the two implant and two tablet groups conflated. Figure 1C shows the outcomes by the four treatment groups including the two different implant groups. When a statistical analysis was done of the type of implant used including no implant, there was a significant difference (Chi squared = 20.93, df = 3, P = 0.001). However when the two implants alone were compared the difference was not significant (WW = 90.00, Gehan's test statistic = 0.77, P = 0.43). Figure 1D shows the outcome by the presence or absence of naltrexone in the urine (WW = 1961.0, Gehan's test statistic = 2.4089, P = 0.1600).


Psychosocial and treatment correlates of opiate free success in a clinical review of a naltrexone implant program.

Reece AS - Subst Abuse Treat Prev Policy (2007)

Opiate Free Success by: A.: Combined Oral Tablet and Implant Group; B: Perth, USA, Tablet and Historical Groups. C.: Presence or Absence of Urinary Naltrexone. **** – P < 0.0001; ** – P < 0.025.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2211472&req=5

Figure 1: Opiate Free Success by: A.: Combined Oral Tablet and Implant Group; B: Perth, USA, Tablet and Historical Groups. C.: Presence or Absence of Urinary Naltrexone. **** – P < 0.0001; ** – P < 0.025.
Mentions: Figure 1 shows the proportion of patients complying with treatment by the various treatment groups. Figure 1A shows the outcome by the three treatment groups. Figure 1B illustrates the respective outcomes by the two implant and two tablet groups conflated. Figure 1C shows the outcomes by the four treatment groups including the two different implant groups. When a statistical analysis was done of the type of implant used including no implant, there was a significant difference (Chi squared = 20.93, df = 3, P = 0.001). However when the two implants alone were compared the difference was not significant (WW = 90.00, Gehan's test statistic = 0.77, P = 0.43). Figure 1D shows the outcome by the presence or absence of naltrexone in the urine (WW = 1961.0, Gehan's test statistic = 2.4089, P = 0.1600).

Bottom Line: The Kaplan Meier 12 month OFS were 82%, 58% and 52% respectively. 12 post-treatment variables were independently associated with treatment retention.Consistent with the voluminous international literature clinically useful retention rates can be achieved with naltrexone, which may be improved by implants and particularly serial implants, repeat detoxification, meticulous clinical follow-up, and social support.As depot formulations of naltrexone become increasingly available such results can guide their clinical deployment, improve treatment outcomes, and enlarge the policy options for an exciting non-addictive pharmacotherapy for opiate addiction.

View Article: PubMed Central - HTML - PubMed

Affiliation: Southcity Family Medical Centre, University of Queensland, 39 Gladstone Rd., Highgate Hill, Brisbane, Queensland, 4101, Australia. sreece@bigpond.net.au

ABSTRACT

Background: There is on-going controversy in relation to the efficacy of naltrexone used for the treatment of heroin addiction, and the important covariates of that success. We were also interested to review our experience with two depot forms of implantable naltrexone.

Methods: A retrospective review of patients' charts was undertaken, patients were recalled by telephone and by letter, and urine drug screen samples were collected. Opiate free success (OFS) was the parameter of interest. Three groups were defined. The first two were treated in the previous 12 months and comprised "implant" and "tablet" patients. A third group was "historical" comprising those treated orally in the preceding 12 months.

Results: There were 102, 113 and 161 patients in each group respectively. Groups were matched for age, sex, and dose of heroin used, but not financial status or social support. The overall follow-up rate was 82%. The Kaplan Meier 12 month OFS were 82%, 58% and 52% respectively. 12 post-treatment variables were independently associated with treatment retention. In a Cox proportional hazard multivariate model social support, the number of detoxification episodes, post-treatment employment, the use of multiple implant episodes and spiritual belief were significantly related to OFS.

Conclusion: Consistent with the voluminous international literature clinically useful retention rates can be achieved with naltrexone, which may be improved by implants and particularly serial implants, repeat detoxification, meticulous clinical follow-up, and social support. As depot formulations of naltrexone become increasingly available such results can guide their clinical deployment, improve treatment outcomes, and enlarge the policy options for an exciting non-addictive pharmacotherapy for opiate addiction.

Show MeSH
Related in: MedlinePlus