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A systematic review on the efficacy of naltrexone maintenance treatment in opioid dependence
Ursula Kirchmayer1, Marina Davoli, Annette D Verster
1Department of Epidemiology, ASL RM/E, Rome, Italy. setil@asplazio.it
Aim:
To evaluate the efficacy of naltrexone maintenance treatment in preventing relapse in opioid addicts after detoxification.
Design:
A systematic review according to the methodology developed by the Cochrane Collaboration based on either randomized controlled trials (RCTs) or controlled clinical trials (CCTs).
Participants:
Seven hundred and seven heroin dependent in- and out-patients, or former heroin addicts dependent on methadone and participating in a naltrexone treatment programme; 89% were male.
Intervention:
Maintenance treatments on opiate dependent people after detoxification, comparing naltrexone with placebo, pharmacological or behavioural treatments.
Measurements:
The outcomes considered were successfully completed treatment, opioid use under treatment (re)-incarcerations during the study period, mean duration of treatment.
Findings:
The outcomes tended to be slightly although not significantly in favour of the naltrexone groups. Use of naltrexone in addition to behavioural treatment significantly decreased the probability of (re-)incarceration (OR=0.30; 95% CI 0.12, 0.76). The difficulties in producing a quantitative analysis were due mainly to the heterogeneity of the included studies.
Conclusions:
From the available clinical trials performed up to this time, there is insufficient evidence to justify the use of naltrexone in maintenance treatment of opioid addicts.
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