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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.

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Significant Treatment Trend Analysis: A.: Detox episodes; B.: Implant episode numbers
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Figure 4: Significant Treatment Trend Analysis: A.: Detox episodes; B.: Implant episode numbers

Mentions: Table 5 lists detailed outcome data by various treatment parameters. Figure 2 shows the outcome for selected psychosocial variables, and Figure 3 illustrates outcomes for selected treatment variables. Table 6 lists the bivariate significance of these various relationships. Dichotomous and multiple response variables have been analyzed in closely related but differing statistical modules within the software giving rise to the varying statistics presented for each variable. The following variables are significant on bivariate analysis: post-treatment employment, the number of detox's, social support, the use of implants rather than tablets, and the number of implants administered (all P ≤ 0.001), the treatment group in which patients were, the type of implant (as discussed above), financial status, the presence of morphine on urine drug screen, spirituality, olanzepine on urine testing, and naltrexone urine positivity were all significant (P < 0.05). Other variables identified were not significantly related to outcome. It is noteworthy that the trend for the number of implants was of borderline significance (S-score = 8, Sens slope estimate 8.44, Mann-Kendall statistic = 1.959, P = 0.0500) and for the number of detox's was highly significant (S-score = 19, Sens slope estimate = 14.56, Mann-Kendall statistic 2.853, P = 0.0043) as illustrated for both variables in Figure 4.


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)

Significant Treatment Trend Analysis: A.: Detox episodes; B.: Implant episode numbers
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Significant Treatment Trend Analysis: A.: Detox episodes; B.: Implant episode numbers
Mentions: Table 5 lists detailed outcome data by various treatment parameters. Figure 2 shows the outcome for selected psychosocial variables, and Figure 3 illustrates outcomes for selected treatment variables. Table 6 lists the bivariate significance of these various relationships. Dichotomous and multiple response variables have been analyzed in closely related but differing statistical modules within the software giving rise to the varying statistics presented for each variable. The following variables are significant on bivariate analysis: post-treatment employment, the number of detox's, social support, the use of implants rather than tablets, and the number of implants administered (all P ≤ 0.001), the treatment group in which patients were, the type of implant (as discussed above), financial status, the presence of morphine on urine drug screen, spirituality, olanzepine on urine testing, and naltrexone urine positivity were all significant (P < 0.05). Other variables identified were not significantly related to outcome. It is noteworthy that the trend for the number of implants was of borderline significance (S-score = 8, Sens slope estimate 8.44, Mann-Kendall statistic = 1.959, P = 0.0500) and for the number of detox's was highly significant (S-score = 19, Sens slope estimate = 14.56, Mann-Kendall statistic 2.853, P = 0.0043) as illustrated for both variables in Figure 4.

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