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Published on: January 29, 2017
Problem drinking and low-dose naltrexone-assisted opioid detoxification.
Paolo Mannelli1, Kathleen Peindl, Ashwin A Patkar
1Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2218 Elder Street, Suite 123, Durham, North Carolina 27705, USA. paolo.mannelli@duke.edu
Problem drinking worsens opioid detoxification outcomes. Very-low-dose naltrexone (VLNTX) improved withdrawal symptoms and treatment completion for patients with combined alcohol and opioid dependence.
Area of Science:
- Addiction Medicine
- Pharmacology
- Clinical Psychology
Background:
- Alcohol use complicates opioid dependence treatment, necessitating effective strategies.
- Very-low-dose naltrexone (VLNTX) has shown promise in reducing withdrawal intensity during methadone taper.
Purpose of the Study:
- To investigate the impact of problem drinking on opioid detoxification outcomes.
- To assess the influence of VLNTX on withdrawal symptoms in patients with co-occurring alcohol and opioid dependence.
Main Methods:
- A double-blind, randomized trial involving 174 opioid-dependent patients undergoing methadone-based detoxification.
- Participants received either VLNTX (0.125 or 0.250 mg/day) or placebo during a 6-day inpatient detoxification.
- Alcohol consumption was assessed at admission; outcomes included withdrawal intensity, craving, and treatment retention.
Main Results:
- Patients with problem drinking exhibited increased opioid withdrawal intensity, craving, and lower treatment retention rates.
- VLNTX treatment in patients with co-occurring alcohol and opioid dependence led to reduced withdrawal symptoms and better treatment completion.
- VLNTX was associated with decreased resumption of alcohol intake post-discharge and showed specific effects on anxiety, nausea, and craving.
Conclusions:
- Heavy alcohol consumption is linked to poorer outcomes in opioid detoxification.
- VLNTX is a safe adjunct treatment that can mitigate withdrawal symptoms and improve completion rates in patients with combined alcohol-opioid dependence.
- Further research is warranted to explore VLNTX for combined alcohol-opioid dependence and alcohol dependence alone.
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