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Naltrexone for Initiation and Maintenance of Opiate Abstinence

  • Chapter
Opiate Receptors and Antagonists

Part of the book series: Contemporary Neuroscience ((CNEURO))

Abstract

Pharmacotherapies for opiate dependence first involve detoxification from physical dependence on opiates and then maintenance of that abstinent state. There are now three agents of distinct pharmacological classes available to achieve both phases: the opiate agonist methadone, the partial opioid agonist buprenorphine, and the opioid antagonist naltrexone. This chapter reviews the role of naltrexone in current opiate detoxification strategies and its use in long-term maintenance of sobriety from opiates.

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References

  1. Sloboda Z. Drug abuse patterns in the United States. In: Epidemiologic Trends in Drug Abuse. Volume II: Proceeding of the International Epidemiology Work Group on Drug Abuse. National Institutes of Health, Bethesda, MD, 1999; pp. 89–107.

    Google Scholar 

  2. Substance Abuse and Mental Health Services Administration: Summary of Findings from the 2004 National Household Survey on Drug Abuse. (2005) accessed at www.oas.samsha.gov/nsduhlatest.htm

  3. White AG, Birnbaum HG, Mareva MN, Daher M, Vallow S, Schein J, Katz N. Direct costs of opioid abuse in an insured population in the United States. J. Manag. Care Pharm. 2005; 11:469–479.

    PubMed  Google Scholar 

  4. Rounsaville BJ, Kosten TR. Treatment for opioid dependence: quality and access. JAMA 2000; 283:1337–1339.

    Article  CAS  PubMed  Google Scholar 

  5. O'Connor PG, Carroll KM, Shi JM, Schottenfeld RS, Kosten TR, Rounsaville BJ. Three methods of opioid detoxification in a primary care setting. A randomized trial. Ann. Intern. Med. 1997; 127:526–530.

    PubMed  Google Scholar 

  6. Gowing L, Ali R, White J. Opioid antagonists and adrenergic agonists for the management of opioid withdrawal. Cochrane Database Syst Rev [computer file] 2000b; (2):CD002021.

    Google Scholar 

  7. Gerra G, Zaimovic A, Rustichelli P, Fontanesi B, Zambelli U, Timpano M, Bocchi C, Delsignore R. Rapid opiate detoxification in outpatient treatment: relationship with naltrexone compliance. J. Subst. Abuse Treat. 2000; 18:185–191.

    Article  CAS  PubMed  Google Scholar 

  8. Rosen MI, McMahon TJ, Hameedi FA, Pearsall HR, Woods SW, Kreek MJ, Kosten TR. Effect of clonidine pretreatment on naloxone-precipitated opiate withdrawal. J. Pharmacol. Exp. Ther. 1996; 276:1128–1135.

    CAS  PubMed  Google Scholar 

  9. Kleber HD, Topazian M, Gaspari J, Riordan CE, Kosten T. Clonidine and naltrexone in the outpatient treatment of heroin withdrawal. Am. J. Drug Alcohol Abuse 1987; 13:1–17.

    Article  CAS  PubMed  Google Scholar 

  10. O'Connor PG, Waugh ME, Carroll KM, Rounsaville BJ, Diagkogiannis IA, Schottenfeld RS. Primary care-based ambulatory opioid detoxification: the results of a clinical trial. J. Gen. Intern. Med. 1995; 10:255–260.

    Article  PubMed  Google Scholar 

  11. Charney DS, Heninger GR, Kleber HD. The combined use of clonidine and naltrexone as a rapid, safe and effective treatment of abrupt withdrawal from methadone. Am. J. Psychiat. 1986; 143:831–837.

    CAS  PubMed  Google Scholar 

  12. Gerra G, Marcato A, Caccavari R, Fontanesi B, Delsignore R, Fertonani G, Avanzini P, Rustichelli P, Passeri M. Clonidine and opiate receptor antagonists in the treatment of heroin addiction. J. Subst. Abuse Treat. 1995; 12:35–41.

    Article  CAS  PubMed  Google Scholar 

  13. Vining E, Kosten TR, Kleber HD. Clinical utility of rapid clonidine-naltrexone detoxification for opioid abusers. Br. J. Addict. 1988; 83:567–575.

    Article  CAS  PubMed  Google Scholar 

  14. Foo H, Westbrook RF. Naloxone-induced hypoalgesia: effects of noradrenergic antagonists and agonist. Pharmacol. Biochem. Behav. 1991; 39:795–797.

    Article  CAS  PubMed  Google Scholar 

  15. Marrazzi MA, Wroblewski JM, Kinzie J, Luby ED. High-dose naltrexone and liver function safety. Am. J. Addict. 1997; 6:21–29.

    CAS  PubMed  Google Scholar 

  16. Kahn A, Mumford JP, Rogers GA, Beckford H. Double-blind study of lofexidine and clonidine in the detoxification of opiate addicts in hospital. Drug Alcohol Depend. 1997; 44:57–61.

    Article  CAS  PubMed  Google Scholar 

  17. Lin SK, Strang J, Su LW, Tsai CJ, Hu WH. Double-blind randomised controlled trial of lofexidine versus clonidine in the treatment of heroin withdrawal. Drug Alcohol Depend. 1997; 48:127–133.

    Article  CAS  PubMed  Google Scholar 

  18. Gerra G, Zaimovic A, Giusti F, Di Gennaro C, Zambelli U, Gardini S, Delsignore R. Lofexidine versus clonidine in rapid opiate detoxification. J. Subst. Abuse Treat. 2001; 21:11–17.

    Article  CAS  PubMed  Google Scholar 

  19. Kosten, TR. Buprenorphine for opioid detoxification. Addict. Disord. Treat. 2003; 2:107–112.

    Article  Google Scholar 

  20. Gowing L, Ali R, White J. Buprenorphine for the management of opioid withdrawal. Cochrane Database Syst Rev [computer file] 2000a; (3):CD002025.

    Google Scholar 

  21. Nigam AK, Ray R, Tripathi BM. Buprenorphine in opiate withdrawal: a comparison with clonidine. J. Subst. Abuse Treat. 1993; 10:391–394.

    Article  CAS  PubMed  Google Scholar 

  22. Janiri L, Mannelli P, Persico AM, Serretti A, Tempesta E. Opiate detoxification of methadone maintenance patients using lefetamine, clonidine and buprenorphine. Drug Alcohol Depend. 1994; 36:139–145.

    Article  CAS  PubMed  Google Scholar 

  23. Umbricht A, Montoya ID, Hoover DR, Demuth KL, Chiang CT, Preston KL. Naltrexone shortened opioid detoxification with buprenorphine. Drug Alcohol Depend. 1999; 56:181–190.

    Article  CAS  PubMed  Google Scholar 

  24. Cheskin LJ, Fudala PJ, Johnson RE. A controlled comparison of buprenorphine and clonidine for acute detoxification from opioids. Drug Alcohol Depend. 1994; 36:115–121.

    Article  CAS  PubMed  Google Scholar 

  25. Amass L, Bickel WK, Higgins ST, Hughes JR. A preliminary investigation of outcome following gradual or rapid buprenorphine detoxification. J. Addict. Dis. 1994; 13:33–45.

    Article  CAS  PubMed  Google Scholar 

  26. Rosen M, Kosten TR. Detoxification and induction onto naltrexone. In: Cowen A and Lewis JW, Eds., Buprenorphine. Combating Drug Abuse with a Unique Opioid. Wiley-Liss, New York, New York, 1995; pp. 289–305.

    Google Scholar 

  27. O'Connor PG, Kosten TR. Rapid and ultrarapid opioid detoxification techniques. JAMA 1998; 279:229–234.

    Article  PubMed  Google Scholar 

  28. Rothman RB, Ni Q, Xu H. Byprenorphine A review of the binding literature. In: Cowen A and Lewis JW, Eds., Buprenorphine. Combating Drug Abuse with a Unique Opioid. Wiley-Liss, New York, New York, 1995; pp. 19–29.

    Google Scholar 

  29. Loimer N, Schmid R, Presslich O, Lenz K. Naloxone treatment for opiate withdrawal syndrome. Br. J. Psychiatry 1988; 153:851–852.

    Article  CAS  PubMed  Google Scholar 

  30. Loimer N, Schmid R, Lenz K, Presslich O, Grunberger J. Acute blocking of naloxone-precipi- tated opiate withdrawal symptoms by methohexitone. Br. J. Psychiatry 1990; 157:748–752.

    Article  CAS  PubMed  Google Scholar 

  31. Legarda JJ, Gossop M. A 24-h inpatient detoxification treatment for heroin addicts: a preliminary investigation. Drug Alcohol Depend. 1994; 35:91–93.

    Article  CAS  PubMed  Google Scholar 

  32. Barttner T, Gooberman LL. Rapid opiate detoxification. Am. J. Drug Alcohol Abuse 1996; 22:489–495.

    Article  Google Scholar 

  33. Strang J, Bearn J, Gossop M. Opiate detoxification under anaesthesia. Br. Med. J. 1997; 315:1249–1250.

    CAS  Google Scholar 

  34. Elman I, D'Ambra MN, Krause S, Breiter H, Kane M, Morris R, Tuffy L, Gastfriend DR. Ultrarapid opioid detoxification: effects on cardiopulmonary physiology, stress hormones and clinical outcomes. Drug Alcohol Depend. 2001; 61:163–172.

    Article  CAS  PubMed  Google Scholar 

  35. Scherbaum N, Klein S, Kaube H, Kienbaum P, Peters J, Gastpar M. Alternative strategies of opiate detoxification: evaluation of the so-called ultra-rapid detoxification. Pharmacopsychiatry 1998; 31:205–209.

    Article  CAS  PubMed  Google Scholar 

  36. Cucchia AT, Monnat M, Spagnoli J, Ferrero F, Bertschy G. Ultra-rapid opiate detoxification using deep sedation with oral midazolam: short and long-term results. Drug Alcohol Depend. 1998; 52:243–250.

    Article  CAS  PubMed  Google Scholar 

  37. Hensel M, Kox WJ. Safety, efficacy, and long-term results of a modified version of rapid opiate detoxification under general anaesthesia: a prospective study in methadone, heroin, codeine and morphine addicts. Acta Anaesthesiol. Scand. 2000; 44:326–333.

    Article  CAS  PubMed  Google Scholar 

  38. Rabinowitz J, Cohen H, Tarrasch R, Kotler M. Compliance to naltrexone treatment after ultra- rapid opiate detoxification: an open label naturalistic study. Drug Alcohol Depend. 1997; 47:77–86.

    Article  CAS  PubMed  Google Scholar 

  39. Albanese AP, Gevirtz C, Oppenheim B, Field JM, Abels I, Eustace JC. Outcome and six month follow up of patients after Ultra Rapid Opiate Detoxification (UROD). J. Addict. Dis. 2000; 19:11–28.

    Article  CAS  PubMed  Google Scholar 

  40. Lawental E. Ultra rapid opiate detoxification as compared to 30-day inpatient detoxification program — a retrospective follow-up study. J. Subst. Abuse 2000; 11:173–181.

    Article  CAS  PubMed  Google Scholar 

  41. Favrat B, Zimmermann G, Zullino D, Krenz S, Dorogy F, Muller J, Zwahlen A, Broers B, Besson J. Opioid antagonist detoxification under anaesthesia versus traditional clonidine detoxification combined with an additional week of psychosocial support: a randomized clinical trial. Drug Alcohol Depend. 2006; 81:109–116.

    Article  CAS  PubMed  Google Scholar 

  42. Bochud Tornay C, Favrat B, Monnat M, Daeppen JB, Schnyder C, Bertschy G, Besson J. Ultra-rapid opiate detoxification using deep sedation and prior oral buprenorphine preparation: long-term results. Drug Alcohol Depend. 2003; 69:283–288.

    Article  CAS  PubMed  Google Scholar 

  43. Collins ED, Kleber HD, Whittington RA, Heitler NE. Anesthesia-assisted vs. buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: a randomized trial. JAMA 2005; 294:903–913.

    Article  CAS  PubMed  Google Scholar 

  44. San L, Puig M, Bulbena A, Farre M. High risk of ultrashort noninvasive opiate detoxification. Am. J. Psychiatry 1995; 152:956.

    CAS  PubMed  Google Scholar 

  45. Pfab R, Hirtl C, Zilker T. Opiate detoxification under anesthesia: no apparent benefit but suppression of thyroid hormones and risk of pulmonary and renal failure. J. Toxicol. Clin. Toxicol. 1999; 37:43–50.

    Article  CAS  PubMed  Google Scholar 

  46. Badenoch J. A death following ultra-rapid opiate detoxification: the General Medical Council adjudicates on a commercialized detoxification. Addiction 2002; 97:475–477.

    Article  PubMed  Google Scholar 

  47. Kleber HD. Naltrexone. J. Subst. Abuse Treat. 1985; 2:117–122.

    Article  CAS  PubMed  Google Scholar 

  48. Lee MC, Wagner HN Jr., Tanada S, Frost JJ, Bice AN, Dannals RF. Duration of occupancy of opiate receptors by naltrexone. J. Nucl. Med. 1988; 29:1207–1211.

    CAS  PubMed  Google Scholar 

  49. Mason BJ, Ritvo EC, Morgan RO, Salvato FR, Goldberg G, Welch B, Mantero-Atienza E. A double-blind, placebo-controlled pilot study to evaluate the efficacy and safety of oral nalmefene HCl for alcohol dependence. Alcohol Clin. Exp. Res. 1994; 18:1162–1167.

    Article  CAS  PubMed  Google Scholar 

  50. Jones HE, Johnson RE, Fudala PJ, Henningfield JE, Heishman SJ. Nalmefene: blockade of intravenous morphine challenge effects in opioid abusing humans. Drug Alcohol Depend. 2000; 60:29–37.

    Article  CAS  PubMed  Google Scholar 

  51. O'Brien CP, Kampman KM. Opioids: antagonists and partial agonists. In: Galanter M and Kleber HD, Eds., Textbook of Substance Abuse Treatment, 3rd Edition, American Psychiatric Publishing Inc., Washington, D.C., 2005; pp. 305–319.

    Google Scholar 

  52. Mitchell JE, Morley JE, Levine AS, Hatsukami D, Gannon M, Pfohl D. High-dose naltrexone therapy and dietary counseling for obesity. Biol. Psychiatry 1987; 22:35–42.

    Article  CAS  PubMed  Google Scholar 

  53. Croop RS, Faulkner EB, Labriola DF. The safety profile of naltrexone in the treatment of alcoholism: results from a multicenter usage study. The Naltrexone Usage Study Group. Arch. Gen. Psychiatry 1997; 54:1130–1135.

    CAS  PubMed  Google Scholar 

  54. Brewer C, Wong VS. Naltrexone: report of lack of hepatotoxicity in acute viral hepatitis, with a review of the literature. Addict. Biol. 2004; 9:81–87.

    Article  CAS  PubMed  Google Scholar 

  55. Dhopesh VP, Taylor KR, Burke WM. Survey of hepatitis B and C in addiction treatment unit. J. Drug Alcohol Abuse. 2000; 26:703–707.

    Article  CAS  Google Scholar 

  56. Hallinan R, Byrne A, Amin J, Dore GJ. Hepatitis C virus prevalence and outcomes among injection drug users on opioid replacement therapy. J. Gastroenterol. Hepatol. 2005; 20:1082–1086.

    Article  PubMed  Google Scholar 

  57. O'Connor PG, Farren CK, Rounsaville BJ, O'Malley SS. A preliminary investigation of the management of alcohol dependence with naltrexone by primary care providers. Am. J. Med. 1997; 103:477–482.

    Article  PubMed  Google Scholar 

  58. Yen MH, Ko HC, Tang FI, Lu RB, Hong JS. Study of hepatotoxicity of naltrexone in the treatment of alcoholism. Alcohol 2006; 38:117–120.

    Article  PubMed  CAS  Google Scholar 

  59. Bertolotti M, Ferrari A, Vitale G, Stefani M, Trenti T, Loria P, Carubbi F, Carulli N, Sternieri E. Effect of liver cirrhosis on the systemic availability of naltrexone in humans. J. Hepatol. 1997; 27:505–511.

    Article  CAS  PubMed  Google Scholar 

  60. Mendelson JH, Ellinboe J, Kuehnle JC, Mello NK. Heroin and naltrexone effects on pituitary- gonadal hormones in man: interaction of steroid feedback effects, tolerance and supersensitiv- ity. J. Pharmacol. Exp. Ther. 1980; 214:503–506.

    CAS  PubMed  Google Scholar 

  61. Porter SJ, Somogyi AA, White JM. Kintetics and inhibition of the formation of 6-beta- naltrexol from nalterexone in human liver cytosol. Br. J. Clin. Pharmacol. 2000; 50:465–471.

    Article  CAS  PubMed  Google Scholar 

  62. Manny I, O'Brien CP, Woody G. Interaction between thioridazine and naltrexone. Am. J. Psychiatry 1987; 144:966.

    Google Scholar 

  63. Crowley T, Wagner J, Zerbe G, Macdonald M. Naltrexone-induced dysphoria in former opioid addicts. Am. J. Psychiatry 1985; 142:1081–1084.

    CAS  PubMed  Google Scholar 

  64. Miotto K, McCann M, Basch J, Rawson R, Ling W. Naltrexone and dysphoria — fact or fiction? Am. J. Psychiatry 2002; 11:151–160.

    Google Scholar 

  65. Dean AJ, Saunders JB, Jones RT, Young RM, Connor JP, Lawford BR. Does naltrexone treatment lead to depression? Findings from a randomized controlled trial in subjects with opioid dependence. J. Psychiatry Neurosci. 2004; 31:38–45.

    Google Scholar 

  66. Hollister LE. Clinical evaluation of naltrexone treatment of opiate-dependent individuals. Report of the national research council committee on clinical evaluation of narcotic antagonists. Arch. Gen. Psychiatry 1978; 35:335–340.

    Google Scholar 

  67. Shufman EN, Porat S, Witztum E, Gandacu D, Bar-Hamburger R, Ginath Y. The efficacy of nal- trexone in preventing reabuse of heroin after detoxification. Biol. Psychiatry 1994; 35:935–945.

    Article  CAS  PubMed  Google Scholar 

  68. Hulse GK, Basso MR. Reassessing naltrexone maintenance as a treatment for illicit heroin users. Drug Alcohol Rev. 1999; 18:263–269.

    Article  Google Scholar 

  69. Curren S, Savage C. Patient response to naltrexone: issues of acceptance, treatment effects, and frequency of administration. NIDA Res. Monogr. 1976; 9:67–69.

    Google Scholar 

  70. San L, Pomarol G, Peri JM, Olle JM, Cami J. Follow-up after a six-month maintenance period on naltrexone versus placebo in heroin addicts. Br. J. Addict. 1991; 86:983–990.

    Article  CAS  PubMed  Google Scholar 

  71. Lerner A, Sigal M, Bacalu A, Shiff R, Burganski I, Gelkopf M. A naltrexone double blind placebo controlled study in Israel. Isr. J. Psychiatry Relat. Sci. 1992; 29:36–43.

    CAS  PubMed  Google Scholar 

  72. Kirchmayer U, Davoli M, Verster A. Naltrexone maintenance treatment for opioid dependence. Cochrane Database Syst. Rev. 2001; 2(CD001333).

    Google Scholar 

  73. Kirchmayer U, Davoli M, Verster A. A systematic review on the efficacy of naltrexone maintenance treatment in opioid dependence. Addiction 2002; 97:1241–1249.

    Article  PubMed  Google Scholar 

  74. Minozzi S, Amato L, Vacchi S, Davoli M, Kirchmayer U, Verster A. Oral naltrexone maintenance treatment for opioid dependence. Cochrane Database Syst. Rev. 2006; 1:Art. No. CD001333.pub2. DOI: 10.1002/14651858.

    PubMed  Google Scholar 

  75. Johansson BA, Berglund M, Lindgren A. Efficacy of maintenance treatment with naltrexone for opioid dependence: a meta-analytical review. Addiction 2006; 101:491–503.

    Article  PubMed  Google Scholar 

  76. Greenstein RA, Arndt IC, McLellan AT, O'Brien CP, Evans B. Naltrexone: a clinical perspective. J. Clin. Psychiatry 1985; 45:25–28.

    Google Scholar 

  77. Chiang CN, Hollister LE, Gillespie HK, Foltz RL. Clinical evaluation of a naltrexone sustained-release preparation. Drug Alcohol Depend. 1985; 16:1–8.

    Article  CAS  PubMed  Google Scholar 

  78. Comer SD, Collins ED, Kleber HD, Nuwayser ES, Kerrigan JH, Fischman MW. Depot naltrexone: long-lasting antagonism of the effects of heroin in humans. Psychopharmacology 2002; 159:351–360.

    Article  CAS  PubMed  Google Scholar 

  79. Modesto-Lowe V, Van Kirk J. Clinical uses of naltrexone: a review of the evidence. Exp. Clin. Psychopharmacol 2002; 10:213–227.

    Article  CAS  PubMed  Google Scholar 

  80. Alim TN, Tai B, Chiang CN, Green T, Rosse RB, Lindquist T, Deutsch SI. Tolerability of a depot form of naltrexone in substance abusers. In: Harris LS, Ed., Problems of Drug Dependence 1994, Vol. 2, NIDA Research Monograph No. 153 (NIH Publication No 95–3883, U.S. Government Printing Office, Washington, D.C., 1995; p. 253.

    Google Scholar 

  81. Kranzler HR, Modesto-Lowe V, Nuwayser ES. Sustained-release naltrexone for alcoholism treatment: a preliminary study. Alcohol Clin. Exp. Res. 1998; 22:1074–1079.

    CAS  PubMed  Google Scholar 

  82. Walsh SL, Sullivan JT, Preston KL, Garner JE, Bigelow GE. Effects of naltrexone on response to intravenous cocaine, hydromorphone and their combination in humans. J. Pharmacol. Exp. Ther. 1996; 279:524–538.

    CAS  PubMed  Google Scholar 

  83. Meyer MC, Straughn MB, Lo MW, Schary WL, Whitney CC. Bioequivalence, dose-proportionality, and pharmacokinetics of naltrexone after oral administration. J. Clin. Psychiatry 1984; 45:15–19.

    CAS  PubMed  Google Scholar 

  84. Judson BA, Carney TM, Goldstein A. Naltrexone treatment of heroin addiction: efficacy and safety in a double-blind safety comparison. Drug Alcohol Depend. 1981; 7:325–346.

    Article  CAS  PubMed  Google Scholar 

  85. Preston KL, Bigelow GE. Differential naltrexone antagonism of hydromorphone and pentazo- cine effects in human volunteers. J. Pharmacol. Exp. Ther. 1993; 264:813–823.

    CAS  PubMed  Google Scholar 

  86. Schuh KJ, Walsh SL, Stitzer ML. Onset, magnitude and duration of opioid blockade produced by buprenorphine and naltrexone in humans. Psychopharmacology 1999; 145: 162–174.

    Article  CAS  PubMed  Google Scholar 

  87. Comer SD, Sullivan MA, Yu E, Rothenberg JL, Kleber HD, Kampman K, Dackis C, O'Brien CP Injectable, sustained-release naltrexone for the treatment of opioid dependence. Arch. Gen. Psychiatry 2006; 63:210–218.

    Article  CAS  PubMed  Google Scholar 

  88. Johnson BA, Ait-Daoud N, Aubin HJ, Van Den Brink W, Guzzetta R, Loewy J, Silverman B, Ehrich E. A pilot evaluation of the safety and tolerability of repeat dose administration of long-acting injectable naltrexone (Vivitrex) in patients with alcohol dependence. Alcohol. Clin. Exp. Res. 2004; 28:1356–1361.

    Article  CAS  PubMed  Google Scholar 

  89. Dunbar JL, Turncliff RZ, Dong Q, Silverman BL, Ehrich EW, Lasseter KC. Single- and multiple-dose pharmacokinetics of long-acting injectable naltrexone. Alcohol. Clin. Exp. Res. 2006; 30:480–490.

    Article  CAS  PubMed  Google Scholar 

  90. Turncliff RZ, Dunbar JL, Dong Q, Silverman BL, Ehrich EW, Dilzer SC, Lasseter KC. Pharmacokinetics of long-acting naltrexone in subjects with mild to moderate hepatic impairment. J. Clin. Pharmacol. 2005; 45:1259–1267.

    Article  CAS  PubMed  Google Scholar 

  91. Foster J, Brewer C, Steele T. Naltrexone implants can completely prevent early (1-month) relapse after opiate detoxification: a pilot study of two cohorts totaling 101 patients with a note on naltrexone blood levels. Addict. Biol. 2003; 8:211–217.

    Article  CAS  PubMed  Google Scholar 

  92. Hulse GK, Arnold-Reed DE, O'Neil G, Chan CT, Hansson R, O'Neil P. Blood naltrex- one and 6-beta-naltrexol levels following naltrexone implant: comparing two naltrexone implants. Addict. Biol. 2004; 9:59–65.

    CAS  Google Scholar 

  93. Hulse GK, Arnold-Reed DE, O'Neil G, Chan CT, Hansson RC. Achieving long-term continuous blood naltrexone and 6-beta-naltrexol coverage following sequential naltrexone implants. Addict. Biol. 2004; 9:67–72.

    Article  CAS  PubMed  Google Scholar 

  94. Hulse GK, Tait RJ, Comer SD, Suillivan MA, Jacobs IG, Arnold-Reed D. Reducing hospital presentations for opioid overdose in patients treated with sustained release naltrexone implants. Drug Alcohol Depend. 2005; 79:351–357.

    Article  PubMed  Google Scholar 

  95. Waal H, Frogopsahl G, Olsen L, Christophersen AS, Morland J. Naltrexone implants — duration, tolerability and clinical usefulness. A pilot study. Eur. Addict. Res. 2006; 12:138–144.

    Article  PubMed  Google Scholar 

  96. Kosten TR, Rounsaville BJ, Kleber HD. Relationship of depression to psychosocial stressors in heroin addicts. J. Nerv. Ment. Dis. 1983; 171:97–104.

    Article  CAS  PubMed  Google Scholar 

  97. Kosten TR, Rounsaville BJ, Kleber HD. A 2.5 year follow up of cocaine use among treated opiate addicts. Have our treatments helped? Arch. Gen. Psychiatry 1987; 44:281–284.

    CAS  PubMed  Google Scholar 

  98. Sinha R, Catapano D, O'Malley SS. Stress-induced craving and stress response in cocaine dependent individuals. Psychopharmacology (Berl) 1999; 142:343–351.

    Article  CAS  Google Scholar 

  99. Sinha R, Fuse T, Aubin LR, O'malley SS. Psychological stress, drug-related cues and cocaine craving. Psychopharmacology (Berl) 2000; 152:140–148.

    Article  CAS  Google Scholar 

  100. Shaham Y, Stewart J. Stress reinstates heroin-seeking in drug-free animals: an effect mimicking heroin, not withdrawal. Psychopharmacology (Berl) 1995; 119:334–341.

    Article  CAS  Google Scholar 

  101. Shaham Y, Highfield D, Delfs J, Leung S, Stewart J. Clonidine blocks stress-induced reinstatement of heroin seeking in rats: an effect independent of locus coeruleus noradrenergic neurons. Eur. J. Neurosci. 2000; 12:292–302.

    Article  CAS  PubMed  Google Scholar 

  102. Sinha R, Holtzman K, Hogan I, Meandzija B, Kimmerling A, Scanley BE, Kosten TR. Lofexidine: enhancing naltrexone treatment to prevent stress-related opiate relapse. Proceedings of College on Problems of Drug Dependence. 65th Annual Meeting of the College on Problems of Drug dependence, Bal Harbour, Florida, 2003, p. 638.

    Google Scholar 

  103. Landabaso MA, Itaugi I, Jiminez-Lerma JM, Sanz J, Fernandez de Corres B, Araluce K, Calle R, Gutierrez-Fraile M. A randomized trial of adding fluoxetine to a naltrexone treatment program for heroin addicts. Addiction 1998; 93:739–744.

    Article  CAS  PubMed  Google Scholar 

  104. Negus SS. Opioid antagonist effects in animal models related to opioid abuse: drug discrimination and drug self-administration. In: Dean R, Bilsky E, Negus S, Eds., Opioid Receptors and Antagonists: From Bench to Clinic. Humana Press; 2007.

    Google Scholar 

  105. Bennett DA, Lal H. Discriminative stimuli produced by clonidine: an investigation of the possible relationship to adrenoceptor stimulation and hypotension. J. Pharmacol. Exp. Ther. 1982; 223:642–648.

    CAS  PubMed  Google Scholar 

  106. Woolverton WL, Wessinger WD, Balster RL. Reinforcing properties of clonidine in rhesus monkeys. Psychopharmacology (Berl) 1982; 77:17–23.

    Article  CAS  Google Scholar 

  107. Weerts EM, Griffiths RR. Evaluation of the intravenous reinforcing effects of clonidine in baboons. Drug Alcohol Depend. 1999; 53:207–214.

    Article  CAS  PubMed  Google Scholar 

  108. Beuger M, Tommasello A, Schwartz R, Clinton M. Clonidine use and abuse among metha- done program applicants and patients. J. Subst. Abuse Treat. 1998; 15:589–593.

    Article  CAS  PubMed  Google Scholar 

  109. Lanford W, Myrick H, O'Bryan E, Gorman J. A severe case of clonidine dependence and withdrawal. J Psychiatr. Pract. 2003; 9:167–170.

    Article  PubMed  Google Scholar 

  110. Preston KL, Silerman K, Umbricht A, Desjens A, Montoya ID, Schuster CR. Improvement in naltrexone treatment compliance with contingency management. Drug Alcohol Depend. 1999; 54:127–135.

    Article  CAS  PubMed  Google Scholar 

  111. Carroll KM, Ball SA, Nich C, O'Connor PG, Eagan DA, Frankforter TL, Triffleman EG, Shi J, Rounsaville BJ. Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence: efficacy of contingency management and significant other involvement. Arch. Gen. Psychiatry 2001; 58:755–761.

    Article  CAS  PubMed  Google Scholar 

  112. Carroll KM, Sinha R, Nich C, Babuscio T, Rounsaville BJ. Contingency management to enhance naltrexone treatment for opioid dependence: a randomized clinical trial of reinforcement magnitude. Exp. Clin. Psychopharmacol. 2002; 10:54–63.

    Article  CAS  PubMed  Google Scholar 

  113. Fals-Stewart W, O'Farrell T. Behavioral family counseling and naltrexone for male opioid- dependent patients. J. Consult. Clin. Psychol. 2003; 71:432–442.

    Article  PubMed  Google Scholar 

  114. Rothenberg JL, Sullivan MA, Church SH, Seracini A, Collins E, Kleber HD, Nunes E V. Behavioral naltrexone therapy: an integrated treatment for opiate dependence. J. Subst. Abuse Treat. 2002; 23:351–360.

    Article  PubMed  Google Scholar 

  115. Sullivan MA, Rothenberg JL, Bosburg SK, Church SH, Feldman SJ, Epstein EM, Kleber HD, Nunes E V. Predictors of retention in naltrexone maintenance for opioid dependence: analysis of stage I trial. Am. J. Addict. 2006; 15:150–159.

    Article  PubMed  Google Scholar 

  116. Nunes E V, Rothenberg JL, Sullivan MA, Carpenter M, Kleber HD. Behavioral therapy to augment oral naltrexone for opioid dependence: a ceiling on effectiveness? Am. J. Drug Alcohol Abuse 2006; 33:502–517.

    Google Scholar 

  117. Rawson RA, Glazer M, Callahan EJ, Lieberman RP. Naltrexone and behavior therapy for heroin addiction. NIDA Res. Mono gr. 1979; 25:289–295.

    Google Scholar 

  118. Tucker T, Ritter A, Maher C, Jackson H. A randomized control trial of group counseling in a naltrexone treatment program. J. Subst. Abuse Treat. 2004; 27:277–288.

    Article  PubMed  Google Scholar 

  119. Ward J, Hall W, Mattick RP. Role of maintenance treatment in opioid dependence. Lancet 1999; 353:221–226.

    Article  CAS  PubMed  Google Scholar 

  120. Washton AM, Pottash AC, Gold MS. Naltrexone in addicted business executives and physicians. J. Clin. Psychiatry 1984; 45:39–41.

    CAS  PubMed  Google Scholar 

  121. Ling W, Wesson DR. Naltrexone treatment for addicted health-care professionals: a collaborative private practice experience. J. Clin. Psychiatry 1984; 45:46–48.

    CAS  PubMed  Google Scholar 

  122. Roth A, Hogan I, Farren C. Naltrexone plus group therapy for the treatment of opiate-abusing health care professionals. J. Subst. Abuse Treat. 1997; 14:19–22.

    Article  CAS  PubMed  Google Scholar 

  123. Brahen LS, Henderson RK, Capone T, Kordal N. Naltrexone treatment in a jail work-release program. J. Clin. Psychiatry 1984; 45:49–52.

    CAS  PubMed  Google Scholar 

  124. Cornish JW, Metzger DM, Woody GE, Wilson D, McLellan AT, Vandergrift B, O'Brien CP. Naltrexone pharmacotherapy for opioid dependent federal probationers. J. Subst. Abuse Treat. 1997; 14:529–534.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the National Institute on Drug Abuse grants K05-DA00454 (TRK), P50-DA12762, R01-DA05626 and the Department of Veterans Affairs, New England MIRECC.

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Authors and Affiliations

  1. Department of Psychiatry, VA Connecticut Healthcare System, Newington Campus, 555 Willard Avenue, 116A3, Newington, 06111, CT

    Kevin A. Sevarino

  2. Department of Psychiatry and Neuroscience, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, 151-Bldge 110, Rm, 229, Houston, 77030, TX

    Thomas R. Kosten

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  1. Kevin A. Sevarino
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  2. Thomas R. Kosten
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Editors and Affiliations

  1. Life Sciences/Toxicology, Alkermes, Inc., Cambridge, MA, 02139, USA

    Reginald L. Dean III

  2. Department of Pharmacology, College of Osteopathic Medicine, University of New England, Biddleford, ME, 04005, USA

    Edward J. Bilsky

  3. Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, 23298, USA

    S. Stevens Negus

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Sevarino, K.A., Kosten, T.R. (2009). Naltrexone for Initiation and Maintenance of Opiate Abstinence. In: Dean, R.L., Bilsky, E.J., Negus, S.S. (eds) Opiate Receptors and Antagonists. Contemporary Neuroscience. Humana Press. https://doi.org/10.1007/978-1-59745-197-0_12

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