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    Risk factors for craving and relapse in heroin users treated with oral or implant naltrexone

    Access Status
    Fulltext not available
    Authors
    Hulse, G.
    Ngo, H.
    Tait, Robert
    Date
    2010
    Type
    Journal Article
    
    Metadata
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    Citation
    Hulse, G. and Ngo, H. and Tait, R. 2010. Risk factors for craving and relapse in heroin users treated with oral or implant naltrexone. Biological Psychiatry. 68 (3): pp. 296-302.
    Source Title
    Biological Psychiatry
    DOI
    10.1016/j.biopsych.2010.04.003
    ISSN
    0006-3223
    School
    National Drug Research Institute (NDRI)
    URI
    http://hdl.handle.net/20.500.11937/5417
    Collection
    • Curtin Research Publications
    Abstract

    Background: Oral 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. Methods: Heroin-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. Results: Compared 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. Conclusions: Implant 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. © 2010 Society of Biological Psychiatry.

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      CONTEXT: Oral naltrexone hydrochloride effectively antagonizes heroin, but its utility is limited by patient noncompliance. Sustained-release preparations may overcome this limitation.OBJECTIVE: To compare the safety and ...
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      Oral naltrexone is used to treat alcohol and heroin dependence but is associated with poor patient compliance. Sustained-release preparations have been developed to overcome noncompliance. Many sustained-release preparations ...
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