A quasi-experimental comparison demonstrated that, compared with oral naltrexone, injectable naltrexone yielded higher 8-week retention ( 16). One study found that a single administration of XR-naltrexone, at the outset of treatment with oral naltrexone, improved retention for low-severity users at 6 months ( 6).
To date, no randomized controlled studies have compared the efficacy of long-term treatment with oral relative to injectable naltrexone. The Australian (6-month) implant provides sustained naltrexone blood levels of ≥1 ng/mL ( 15) and has been shown to improve adherence, increase abstinence rates, and effectively reduce relapse to opioid dependence, compared with oral naltrexone ( 14). The Russian implant, administered every 2 months, produced 53% retention in treatment over a 6-month trial, compared with 16% for a control group receiving oral naltrexone. Several implants, consisting of pellets surgically implanted under the skin, have been tested one implant, produced in Russia, appears to produce adequate naltrexone blood levels for 2 to 3 months ( 11), and another, produced in Australia, produces adequate levels for up to 6 months ( 12, 14). Two large studies reported that these effects lasted about 4 weeks and produced 6-month retention of about 50% of participants, with patients predominantly abstinent while taking naltrexone ( 10, 13). The intramuscular injection (marketed as Vivitrol) consists of polymer micro-spheres that dissolve slowly, releasing naltrexone at levels in the blood adequate for blocking the effects of exogenous opioids. Extended-release (XR) parenteral formulations of naltrexone, as monthly injection ( 9, 10) or implants ( 11, 12), circumvent the daily pill requirement and have shown promising effectiveness.
Behavioral interventions, such as contingency management and involvement of significant others, have improved adherence to oral naltrexone, but to a limited extent ( 5– 8). However, its clinical utility, when taken orally, has been limited by poor adherence ( 2– 4). However, not all patients will accept methadone or buprenorphine or respond well to it.Īs a high-affinity opioid receptor antagonist, naltrexone represents an alternative treatment to agonist maintenance. When adequately dosed, buprenorphine and methadone reduce or eliminate opioid use and protect against overdose. Agonist maintenance with methadone or buprenorphine remains the preferred treatment.
Opioid use disorder continues to represent an unprecedented harm to public health, as rates of morbidity and mortality related to opioid abuse rise at an alarming rate ( 1). The other authors report no financial relationships with commercial interests.
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Nunes has received medication or software for research studies from Alkermes, Duramed Pharmaceuticals, HealthSim, and Reckitt Benckiser he has served as an investigator for Braeburn Pharmaceuticals he has devices under investigation and has received travel reimbursement from Brainsway and he has received advisory board fees from Eli Lilly and Purdue Pharma and book royalties from Civic Research Institute.
Levin received medication for NIH-funded research studies from US WorldMeds and consulting fees from GW Pharmaceuticals and has served on advisory boards for Eli Lilly and Shire.
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Bisaga received consultation fees and travel reimbursement for training, medical editing, and market research from The Bloc, Clearview Health-care Partners, GLG Research Group, Global Data, Guidepoint Global, Healthcare Research Consulting Group, Motive Medical Intelligence, RAND, and the United Nations Office on Drugs and Crime he received grant funding from Alkermes, medication (extended-release naltrexone) from Alkermes for NIH-funded research studies, was an investigator for a multisite clinical trial funded by Alkermes, and served as an unpaid consultant to Alkermes he received an honorarium for an unbranded educational activity from Indivior and he received book royalties from The Experiment. Sullivan participated in the design and conduct of the study while a full-time faculty member at Columbia University, and she participated in manuscript preparation after becoming an employee of Alkermes.
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