Use of Naltrexone to Treat Opioid Addiction in a Country in Which Methadone and Buprenorphine Are Not Available
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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.
KeywordsNaltrexone Opiate dependence Pharmacotherapy
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.
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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