Current Psychiatry Reports

, Volume 12, Issue 5, pp 448–453 | Cite as

Use of Naltrexone to Treat Opioid Addiction in a Country in Which Methadone and Buprenorphine Are Not Available

Article

Abstract

Opioid dependence is one of the most severe drug dependencies. Naltrexone is a medication that completely blocks the subjective and other effects of opioids and, when administered to detoxified opioid addicts and taken as directed, prevents relapse and helps maintain abstinence. The major problem with naltrexone is poor compliance, particularly in countries in which there is a treatment alternative based on substitution of illicit opioids such as heroin with orally administered opioid agonists (methadone) or partial agonist/antagonists (buprenorphine). In Russia, substitution therapy is forbidden by law, and naltrexone is the only available pharmacotherapy for heroin dependence. Due to the lack of alternatives to naltrexone and stronger family control of compliance (adherence), naltrexone is more effective for relapse prevention and abstinence stabilization in Russia than in Western countries. Long-acting, sustained-release formulations (injectable and implantable) seem particularly effective compared with oral formulations. This article summarizes the results of studies conducted in Russia during the past 10 years that demonstrate these points.

Keywords

Naltrexone Opiate dependence Pharmacotherapy 

Notes

Acknowledgments

The studies of oral naltrexone with or without fluoxetine were supported by National Institute on Drug Abuse grants P60-DA05186l (to Dr. Charles P. O’Brien), U10-DA13043, and K05-DA 17009 (to Dr. Woody) and the Department of Veterans Affairs. The study of implant naltrexone was supported by National Institute on Drug Abuse grant DA017317.

Disclosure

DuPont Pharmaceutical provided naltrexone, and Gideon Richter provided fluoxetine for the studies of oral naltrexone with or without fluoxetine. Fidelity Capital (Russia) provided Prodetoxon at reduced cost. Alkermes (USA) supported the study of injectable naltrexone (Vivitrol) in Russia.

Dr. Krupitsky serves a consultant for Alkermes. No other potential conflicts of interest relevant to this article were reported.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Kleber H: Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues Clin Neurosci 2007, 9:455–470. This an excellent review of pharmacologic treatments for opioid dependence.PubMedGoogle Scholar
  2. 2.
    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.CrossRefPubMedGoogle Scholar
  3. 3.
    O’Brien C, Cornish JW: Naltrexone for probationers and parolees. J Subst Abuse Treat 2006, 31:107–111.CrossRefPubMedGoogle Scholar
  4. 4.
    Washton AM, Pottash AC, Gold MS: Naltrexone in addicted business executives and physicians. J Clin Psychiatry 1984, 45:39–41.PubMedGoogle Scholar
  5. 5.
    Preston KL, Silverman K, Umbricht A, et al.: Improvement in naltrexone treatment compliance with contingency management. Drug Alcohol Depend 1999, 54:127–135.CrossRefPubMedGoogle Scholar
  6. 6.
    Carroll KM, Ball SA, Nich C, et al.: 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.CrossRefPubMedGoogle Scholar
  7. 7.
    Rounsaville B: Can psychotherapy rescue naltrexone treatment of opioid addiction? In Potentiating the Efficacy of Medications: Integrating Psychosocial Therapies With Pharmacotherapies in the Treatment of Drug Dependence. Edited by Onken L, Blaine J. Rockville, MD: National Institute on Drug Abuse; 1995:37–52. [NIDA Research Monograph series no. 105, NIH publication no. 95-3899.]Google Scholar
  8. 8.
    Rothenberg JL, Sullivan MA, Church SH, et al.: Behavioral naltrexone therapy: an integrated treatment for opiate dependence. J Subst Abuse Treat 2002, 23:351–360.CrossRefPubMedGoogle Scholar
  9. 9.
    Nunes EV, Rothenberg JL, Sullivan MA, et al.: Behavioral therapy to augment oral naltrexone for opioid dependence: a ceiling on effectiveness? Am J Drug Alcohol Abuse 2006, 32:503–517.CrossRefPubMedGoogle Scholar
  10. 10.
    •• World Health Organization: Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. Geneva, Switzerland: World Health Organization; 2009. The guidelines review the use of medications such as methadone, buprenorphine, naltrexone, and others in combination with psychosocial support in the treatment of individuals dependent on heroin or other opioids. Based on the systematic review of the literature, the guidelines contain specific recommendations on the range of issues faced in organizing treatment systems, managing treatment programs, and treating those who are dependent on opioids.Google Scholar
  11. 11.
    Krupitsky EM, Zvartau EE, Masalov DV, et al.: Naltrexone for heroin dependence treatment in St. Petersburg, Russia. J Subst Abuse Treat 2004, 26:285–294.CrossRefPubMedGoogle Scholar
  12. 12.
    Krupitsky EM, Burakov AM, Didenko TY, et al.: Effects of citalopram treatment of protracted withdrawal (syndrome of anhedonia) in patients with heroin addiction. Addict Disord Their Treat 2002, 1:29–33.CrossRefGoogle Scholar
  13. 13.
    Krupitsky EM, Zvartau EE, Masalov DV, et al.: Naltrexone with or without fluoxetine for preventing relapse to heroin addiction in St. Petersburg, Russia. J Subst Abuse Treat 2006, 31:319–328.CrossRefPubMedGoogle Scholar
  14. 14.
    Sinha R, Kimmerling A, Doebrick C, Kosten TR: Effects of lofexidine on stress-induced and cue-induced opioid craving and opioid abstinence rates: preliminary findings. Psychopharmacology 2007, 190:569–574.CrossRefPubMedGoogle Scholar
  15. 15.
    Krupitsky E, Zvartau E, Woody G: Long acting naltrexone implants for heroin dependence. Eur Neuropsychopharmacol 2009, 19:192.CrossRefGoogle Scholar
  16. 16.
    • Kruptisky EM, Burakov AM, Tsoy MV, et al.: Overcoming opioid blockade from depot naltrexone (Prodetoxon). Addiction 2007, 102:1164–1165. This case describes a situation in which an opioid-dependent patient overcame naltrexone implant blockade.CrossRefPubMedGoogle Scholar
  17. 17.
    • Hulse GK, Morris N, Arnold-Reed D, et al.: Improving clinical outcomes in treating heroin dependence. Arch Gen Psychiatry 2009, 66:1108–1115. This first double-blind, placebo-controlled, randomized clinical trial showed the effectiveness of the single-dose Australian naltrexone implant in comparison with oral naltrexone. CrossRefPubMedGoogle Scholar
  18. 18.
    • Kunøe N, Lobmaier P, Vederhus JK, et al.: Naltrexone implants after in-patient treatment for opioid dependence: randomized controlled trial. Br J Psychiatry 2009, 194:541–546. This Norwegian study compared the Australian implantable naltrexone with usual-treatment aftercare.CrossRefPubMedGoogle Scholar
  19. 19.
    •• Krupitsky EM, Blokhina EA: Long acting sustained release formulations of naltrexone for heroin dependence: a review. Curr Opin Psychiatry 2010, 23:210–214. This is a review of the most recent data on the variety of long-acting, sustained-release formulations of naltrexone (implantable and injectable) and their use for opiate dependence, including their efficacy and safety.CrossRefGoogle Scholar
  20. 20.
    Volpicelli RG, Fenton M: Sustained-release naltrexone formulations for the treatment of alcohol and opioid dependence. Future Neurol 2006, 1:389–398.CrossRefGoogle Scholar
  21. 21.
    Dunbar JL, Turncliff RZ, Dong Q, et al.: Single- and multiple-dose pharmacokinetics of long-acting injectable naltrexone. Alcohol Clin Exp Res 2006, 30:480–490.CrossRefPubMedGoogle Scholar
  22. 22.
    Comer SD, Sullivan MA, Yu E, et al.: Injectable, sustained-release naltrexone for the treatment of opioid dependence. Arch Gen Psychiatry 2006, 63:210–218.CrossRefPubMedGoogle Scholar
  23. 23.
    Alkermes announces positive results from phase 3 clinical study of naltrexone for extended-release injectable suspension for the treatment of opioid dependence. Cambridge, MA: Alkermes; November 16, 2009. Available at http://investor.alkermes.com/phoenix.zhtml?c = 92211&p = irol-newsArticle&ID = 1355632&highlight.
  24. 24.
    • Fishman M: Precipitated withdrawal during maintenance opioid blockade with extended release naltrexone. Addiction 2008, 103:1399–1401. This clinical case demonstrated that it is possible to overcome opioid blockade with Vivitrol and precipitate withdrawal in some circumstances. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of AddictionsSt. Petersburg Bekhterev Psychoneurological Research InstituteSt.-PetersburgRussia
  2. 2.Department of PharmacologySt. Petersburg State Pavlov Medical UniversitySt. PetersburgRussia
  3. 3.Treatment Research InstitutePhiladelphiaUSA

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