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Cited by 465Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesPain Management and Opioid Use

Maintenance Medication for Opiate Addiction: The Foundation of Recovery

Open access
Bart, Gavin·2012·Journal of Addictive Diseases
DOI 10.1080/10550887.2012.694598PMC PMC3411273
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Abstract

Illicit use of opiates is the fastest growing substance use problem in the United States, and the main reason for seeking addiction treatment services for illicit drug use throughout the world. It is associated with significant morbidity and mortality related to human immunodeficiency virus, hepatitis C, and overdose. Treatment for opiate addiction requires long-term management. Behavioral interventions alone have extremely poor outcomes, with more than 80% of patients returning to drug use. Similarly poor results are seen with medication-assisted detoxification. This article provides a topical review of the three medications approved by the Food and Drug Administration for long-term treatment of opiate dependence: the opioid-agonist methadone, the partial opioid-agonist buprenorphine, and the opioid-antagonist naltrexone. Basic mechanisms of action and treatment outcomes are described for each medication. Results indicate that maintenance medication provides the best opportunity for patients to achieve recovery from opiate addiction. Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function. Oral naltrexone is ineffective in treating opiate addiction, but recent studies using extended-release naltrexone injections have shown promise. Although no direct comparisons between extended-release naltrexone injections and either methadone or buprenorphine exist, indirect comparison of retention shows inferior outcome compared with methadone and buprenorphine. Further work is needed to directly compare each medication and determine individual factors that can assist in medication selection. Until such time, selection of medication should be based on informed choice following a discussion of outcomes, risks, and benefits of each medication.

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that long-term maintenance medication is the strongest foundation for recovery from opiate addiction, with methadone and buprenorphine showing better retention and illicit-use outcomes than naltrexone or non-medication approaches. It reviews mechanisms, outcomes, and special populations, and calls for direct comparative studies to guide individualized medication choice.

Key findings

  • Non-medication treatment and detoxification have poor outcomes: more than 80% return to opiate use within two years after intensive residential treatment, and medication-assisted detoxification does not sustain abstinence beyond initial stabilization.
  • Methadone and buprenorphine maintenance reduce illicit opiate use and craving and improve retention and social function. Methadone stabilization is usually 60–120 mg daily, with mean 1-year retention around 60% and roughly 15% of patients showing ongoing illicit opiate use at any time. Buprenorphine stabilization is usually 12–16 mg daily; 12–24 week retention is similar to methadone, and one small placebo-controlled trial reported 1-year retention of 75% versus 0%.
  • Oral naltrexone is ineffective largely because of poor adherence: fewer than 20% remain in treatment at 6 months, and a Cochrane meta-analysis found it no better than placebo. Extended-release naltrexone shows promise: one trial retained 70% at 8 weeks; a larger Russian trial retained 53% versus 38% for placebo at 6 months; implants showed about 60% retention at 6 months, but indirect comparison suggests inferior retention to methadone and buprenorphine.
  • One randomized comparison found 24-week retention of 84% for methadone 50 mg, 59% for buprenorphine 5 mg, and 21% for naltrexone 50 mg, despite suboptimal methadone and buprenorphine doses. No direct comparisons exist between extended-release naltrexone and either methadone or buprenorphine.

Methods

  • Narrative/topical review of the three FDA-approved medications for long-term opiate dependence: methadone, buprenorphine, and naltrexone. It covers neurobiology, psychosocial-only and detoxification approaches, mechanisms of action, treatment outcomes, direct comparisons, and special populations.
  • Evidence is drawn from existing literature, systematic reviews, and clinical trials; no new primary data collection or formal systematic search/meta-analysis is described.
  • Outcomes emphasized include retention in treatment, illicit opiate use, craving, social function, and safety.

Limitations

  • Stated: no randomized double-blind trial compares all three medications; no direct outcome studies compare extended-release naltrexone with methadone or buprenorphine; buprenorphine studies mostly last 12–24 weeks, so whether retention similarity persists at 1 year is uncertain; more work is needed on direct comparisons and predictors of individual response.
  • Stated: oral naltrexone evidence is limited by high dropout, and extended-release naltrexone data remain limited.
  • Evident: as a topical review, it lacks a described systematic search strategy, inclusion criteria, or formal quality assessment; some special-population recommendations rest on limited or no formal studies, such as buprenorphine pharmacokinetics in end-stage liver disease.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1080/10550887.2012.694598

Cites

149 of 149 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 77 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Behavioral interventions alone have very poor outcomes, with more than 80% of patients returning to drug use.

    “Behavioral interventions alone have extremely poor outcomes, with more than 80% of patients returning to drug use.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [36] Pescor M J, 1943, Publ Health Rep

      Not checked in the free run.

    • cites [37] Vaillant G E, 1973, Arch Gen Psychiatry source

      Not checked in the free run.

  • Premisecitation

    Extended-release naltrexone injections have shown promise for treating opiate addiction.

    “Oral naltrexone is ineffective in treating opiate addiction but recent studies using extended release naltrexone injections have shown promise.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [117] Comer S D, 2006, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [118] Krupitsky E, 2011, Lancet source

      Not checked in the free run.

  • Interpretationreasoning

    Long-term approaches to treating opiate addiction are required because of persistent alterations in dopaminergic, opioidergic, and stress-responsive pathways.

    “Long term approaches to the treatment of opiate addiction are required because of persistent alterations in dopaminergic, opioidergic, and stress responsive pathways.”
    Quote in the paperSubstantial claim
  • Interpretationcitation

    When used alone, psychosocial interventions for opiate addiction lie outside first-line evidence-based treatment.

    “when used alone, these approaches should be considered to lie outside the domain of first-line evidence based treatment”
    Quote in the paperSubstantial claim
  • Interpretationreasoning

    Indirect comparison of retention shows extended-release naltrexone has inferior outcome compared with methadone and buprenorphine.

    “indirect comparison of retention shows inferior outcome compared to methadone and buprenorphine”
    Quote in the paperSubstantial claim
    • Rests on an assumption: An indirect comparison of retention between extended-release naltrexone and methadone or buprenorphine can validly indicate their relative outcome.
  • May combine two claims. 30
  • Classified as probably not a substantial claim. 3

  • May combine two claims.

    Premisecitation

    Historical data show poor outcomes with psychosocial interventions only; return to opiate use approaches 80% within two years of intensive residential treatment.

    “Historical data indicate poor outcome in patients provided only psychosocial interventions. Whether compelled or voluntary, return to opiate use approaches 80% within two years of intensive residential treatment.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [36] Pescor M J, 1943, Publ Health Rep

      Not checked in the free run.

    • cites [37] Vaillant G E, 1973, Arch Gen Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Maintenance treatment with methadone or buprenorphine is associated with retention in treatment, reduced illicit opiate use, decreased craving, and improved social function.

    “Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Illicit opiate use is the fastest growing substance use problem in the United States and the main reason for seeking addiction treatment for illicit drug use worldwide.

    “Illicit use of opiates is the fastest growing substance use problem in the United States and the main reason for seeking addiction treatment services for illicit drug use throughout the world.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [9]

      Not checked in the free run.

    • cites [11] Substance Abuse and Mental Health Services Administration. 2011. “Treatment episode data set”. http://www.dasis.samhsa.gov/webt/quicklink/us09.htm(accessed December 21, 2011).

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The addiction liability of opiates is high: 50% of past-year heroin users and 11% of past-year prescription opiate users meet addiction criteria.

    “The addiction liability of opiates is high with 50% and 11% of people who used heroin or prescription opiates, respectively, last year meeting addiction criteria.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Substance Abuse and Mental Health Services Administration. 2011. “National survey on drug use and health 2010”. http://www.icpsr.umich.edu/cgi-bin/SDA/SAMHDA/hsda?samhda+32722-0001(accessed December 21, 2011)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Psychosocial intervention alone is inferior to methadone maintenance for retention in treatment and reduction in opiate-positive urine toxicology tests.

    “a separate review found that psychosocial intervention alone was inferior to methadone maintenance for such outcomes as retention in treatment and reduction in opiate positive urine toxicology tests”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Mattick R P, 2003, Cochrane Database Syst Rev

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Methadone relieves opiate withdrawal and, at steady state, blocks the euphoric and sedating effects of superimposed opiates.

    “not only did methadone relieve opiate withdrawal but, when at steady-state, it also blocked the euphoric and sedating effects of superimposed opiates”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [60] Dole V P, 1966, Arch Intern Med source

      Not checked in the free run.

    • cites [61] Dole V P, 1965, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a randomized trial, 24-week retention was 84% for methadone 50 mg, 59% for buprenorphine 5 mg, and 21% for naltrexone 50 mg, despite the methadone and buprenorphine doses being suboptimal.

    “One randomized trial comparing each of the medications found 24-week retention rates of 84%, 59%, and 21% for methadone 50mg, buprenorphine 5mg, and naltrexone 50mg, respectively, despite suboptimal doses of methadone and buprenorphine.129”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [129] Ahmadi J, 2003, Eur J Clin Invest source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Naltrexone is without intrinsic opiate activity and poses minimal risk of abuse or diversion.

    “naltrexone is without intrinsic opiate activity and poses minimal risk abuse or diversion”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Naltrexone's effect on craving in opiate addicts is less clear; oral naltrexone may not reduce craving more than placebo, and if it does, this reduction does not necessarily correlate with abstinence.

    “Naltrexone’s effect on craving in opiate addicts is less clear. Oral naltrexone may not reduce craving more than placebo and if it does, this reduction does not necessarily correlate with abstinence.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [124] Krupitsky E M, 2006, J Subst Abuse Treat source

      Not checked in the free run.

    • cites [125] Dijkstra B AG, 2007, Addiction Biology source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Failure of oral naltrexone to prevent relapse in opiate addicts may be related to ongoing stress dysregulation, supported by animal research showing its failure to suppress stress-induced relapse.

    “Failure of oral naltrexone to prevent relapse in opiate addicts may be related to ongoing stress dysregulation and is supported by animal research showing its failure to suppress stress-induced relapse.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [126] Shaham Y, 1997, J Neurosci. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Subdermal naltrexone implant studies show retention of approximately 60% at 6 months, exceeding that of oral naltrexone.

    “These studies have shown retention of approximately 60% at 6-months, exceeding that of oral naltrexone.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [119] Hulse G K, 2009, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [120] Kunøe N, 2009, Br J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Methadone increases the electrocardiographic QTc interval, but the increase is minimal and rarely exceeds the 500 msec threshold associated with arrhythmia and sudden death in people with heart disease.

    “While methadone will increase the electrocardiographic QTc interval, this appears minimal in magnitude and rarely exceeds the 500 msec threshold associated with cardiac arrhythmia and sudden death in those with heart disease.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [55] Martin J A, 2011, J Addict Dis source

      Not checked in the free run.

    • cites [56] Martell B A, 2005, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Methadone, buprenorphine, and naltrexone are each FDA approved for long-term treatment of opiate addiction.

    “Methadone, buprenorphine, and naltrexone are each FDA approved for the long-term treatment of opiate addiction”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Many of buprenorphine's effects plateau after approximately 16 mg, although doses up to 32 mg are used clinically.

    “many of buprenorphine’s effects plateau after approximately 16 mg, although doses of up to 32mg are used clinically”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Walsh S L, 1994, Clin Pharmacol Ther source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In alcoholism treatment, naltrexone reduces craving, and reduction in baseline craving is correlated with its effectiveness.

    “the literature on its use in the treatment of alcoholism where it reduces craving, a frequent predecessor to relapse. In fact, reduction in base-line craving is correlated with its effectiveness.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [123] Volpicelli J R, 1995, J Clin Psychiatry

      Not checked in the free run.

    • Rests on an assumption: Findings from alcoholism treatment about naltrexone's reduction of craving can inform its use in opiate addiction.

  • May combine two claims.

    Premisecitation

    Mean 1-year retention in methadone treatment is approximately 60% and can vary with adherence to evidence-based dosing practices.

    “Mean 1-year retention in treatment is approximately 60% and can vary based on adherence to evidence-based dosing practices.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [64] Johnson R E, 2000, N Engl J Med source

      Not checked in the free run.

    • cites [65] Strain E C, 1999, JAMA source

      Not checked in the free run.

    • cites [66] Ling W, 1996, Arch Gen Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Methadone and buprenorphine can normalize stress response, whereas naltrexone maintenance may not.

    “Whereas both methadone and buprenorphine can normalize stress response, naltrexone maintenance may not.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Buprenorphine can both induce and relieve opiate withdrawal.

    “Buprenorphine’s ability to both induce and relieve opiate withdrawal was observed by Martin et al. in 1976”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [88] Martin W R, 1976, J Pharmacol Exp Ther source

      Not checked in the free run.

    • cites [89] Jasinski D R, 1978, Arch Gen Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Stress response tends to normalize with methadone stabilization, and hormonal abnormalities seen in addiction and abstinence are corrected during methadone maintenance.

    “Regulation of stress response is one such function that tends to normalize with methadone stabilization.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [52] Kreek M J, 1973, JAMA source

      Not checked in the free run.

    • cites [76] Kreek M J, 1983, Life Sci source

      Not checked in the free run.

    • cites [77] Facchinetti F, 1984, Acta Endocrinol Copenh source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most stress-responsive markers are normalized in buprenorphine-maintained patients, and failure to normalize correlates with craving and relapse.

    “It appears that most stress responsive markers are normalized in buprenorphine maintained patients and that failure to normalize correlates with craving and relapse.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [103] Kakko J, 2008, Biol Psychiatry source

      Not checked in the free run.

    • cites [104] Fatseas M, 2011, Biol Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Methadone response is dose related, with most patients stabilizing at 60 to 120 mg daily.

    “Methadone response appears to be dose related with most patients stabilizing at doses between 60mg–120mg daily.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] National Institutes of Health, 1998, JAMA source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Buprenorphine is a semi-synthetic mu opioid partial agonist with weak partial agonist effects at delta and kappa opioid receptors.

    “Buprenorphine is a semi-synthetic mu opioid partial agonist with weak partial agonist effects at both delta and kappa opioid receptors.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [79] Bentley K W, 1967, J Am Chem Soc source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Naltrexone's antagonist effect can be overcome in acute pain, but caution is advised.

    “Its antagonist effect can be overridden in setting of acute pain but caution is advised.138”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [138] Gastfriend D R, 2011, Ann N Y Acad Sci source

      Not checked in the free run.

    • Rests on an assumption: Naltrexone can prevent the effectiveness of opioid analgesics.

  • May combine two claims.

    Premisecitation

    Pregnant women may have early withdrawal and need higher or split methadone doses in the second and third trimesters because methadone has no active metabolites.

    “Since methadone does not have active metabolites, patients may experience early withdrawal and may require increases in or splitting of methadone dose during the second and third trimesters.133”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [133] Pond S M, 1985, J Pharmacol Exp Ther source

      Not checked in the free run.

    • Rests on an assumption: The placenta is metabolically active and can increase clearance of methadone and buprenorphine.

  • May combine two claims.

    Interpretationnone given

    Each of the three available medications for opiate addiction has better treatment outcomes than non-medication-based therapies.

    “Extensive research shows that each of the three available medications used to treat opiate addiction have superior treatment outcomes to non medication based therapies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Raising the methadone dose to prevent withdrawal may also raise peak methadone levels and cause sedation.

    “Since this will also increase methadone peak levels, it may result in sedation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    That legal precedent does not extend to a specific medication.

    “this precedent does not extend to a specific medication”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [142] Richard J, 2006, Journal of Substance Abuse Treatment source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Methadone and buprenorphine can lower recidivism and illicit opiate use.

    “Each can reduce recidivism and illicit opiate use.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [139] Kinlock T W, 2009, J Subst Abuse Treat source

      Not checked in the free run.

    • cites [140] Magura S, 2009, Drug Alcohol Depend source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Reports comparing short-term detoxification with buprenorphine maintenance in adolescents show better outcomes with longer medication and high relapse after stopping medication.

    “Several reports comparing short-term detoxification to buprenorphine maintenance, however, show better results with longer periods of medication and high rates of relapse following discontinuation of medication.(for a review see 136)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [136]

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Higher methadone clearance may trigger withdrawal, which can be prevented by raising the methadone dose.

    “Increased methadone clearance may result in onset of withdrawal symptoms and can be prevented by increasing methadone dose.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In the MOTHER trial, buprenorphine compared with methadone was linked to shorter neonatal abstinence syndrome and less need for morphine relief, but not lower intensity.

    “the length, but not intensity, of neonatal abstinence syndrome and the neonates’ need for morphine relief was lower in women taking buprenorphine compared to methadone”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [134] Jones H E, 2010, N Engl J Med source

      Not checked in the free run.

31 of 31

  • The authors state this as an assumption.

    Buprenorphine's therapeutic effect in opiate addiction is mediated through partial agonism at the mu opioid receptor.

    “The neurobiological effect of buprenorphine in the treatment of opiate addiction is presumed to be mediated through partial agonism of the mu opioid receptor.”

  • The paper relies on this without support.

    An indirect comparison of retention between extended-release naltrexone and methadone or buprenorphine can validly indicate their relative outcome.

    “indirect comparison of retention shows inferior outcome compared to methadone and buprenorphine”

  • The paper relies on this without support.

    Findings from alcoholism treatment about naltrexone's reduction of craving can inform its use in opiate addiction.

    “What may be most compelling about naltrexone comes from the literature on its use in the treatment of alcoholism where it reduces craving, a frequent predecessor to relapse.”

  • The paper relies on this without support.

    No randomized double-blind controlled trials have compared all three medications (methadone, buprenorphine, naltrexone) for opiate addiction.

    “There are no randomized double-blind controlled trials comparing all three medications.”

  • The paper relies on this without support.

    No comparative outcome studies exist between methadone or buprenorphine and extended-release naltrexone.

    “There are no comparative outcome studies between either methadone or buprenorphine and extended release naltrexone.”

  • The paper relies on this without support.

    No formal studies of buprenorphine pharmacokinetics in end-stage liver disease exist.

    “There are no formal studies of buprenorphine pharmacokinetics in end stage liver disease.”

  • The paper relies on this without support.

    FDA labels for oral and intramuscular naltrexone recommend against their use in end-stage liver disease.

    “FDA labels for both oral and intramuscular naltrexone recommended against their use in the setting of end stage liver disease.”

  • The paper relies on this without support.

    The placenta is metabolically active and can increase clearance of methadone and buprenorphine.

    “The placenta is metabolically active and can increase clearance of both methadone and buprenorphine.”

  • The paper relies on this without support.

    Both methadone and buprenorphine are associated with improved maternal and fetal outcomes compared to abstinence-based approaches.

    “Both methadone and buprenorphine are associated with improved maternal and fetal outcomes compared to abstinence based approaches.”

  • The paper relies on this without support.

    Opiate addiction is often a disease of pediatric onset.

    “Opiate addiction is often a disease of pediatric onset.”

  • The paper relies on this without support.

    Many maintenance patients with chronic pain may require daily or intermittent opioid analgesics.

    “Many of these patients may require daily or intermittent opioid analgesics.”

  • The paper relies on this without support.

    Methadone and buprenorphine have been used for moderate to severe pain.

    “Both methadone and buprenorphine have been used in the treatment of moderate to severe pain”

  • The paper relies on this without support.

    Chronic use of methadone or buprenorphine for opiate addiction does not preclude regular use of opioid analgesics.

    “their chronic use for opiate addiction does not preclude the regular use of opioid analgesics.”

  • The paper relies on this without support.

    Naltrexone can prevent the effectiveness of opioid analgesics.

    “Naltrexone can prevent the effectiveness of opioid analgesics.”

  • The paper relies on this without support.

    No direct comparisons of these medications have been performed in a criminal justice setting.

    “No direct comparisons of these medications have been performed in a criminal justice setting.”

  • The paper relies on this without support.

    Naloxone and naltrexone are Category C.

    “although each are Category C”
16 of 16

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Medications for opioid use disorder (MOUD) are a tool that helps reduce opioid-related overdose mortality.

    “Evidence shows that medications for opioid use disorder (MOUD) are a tool that helps reduce opioid-related overdose mortality.2,3,4”

    From Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder (2023) · cites this paper as [2]

    The Conclusion (page not provided) says that increased retention in medication treatment reduces mortality, and the Methadone section says greater dosing supervision reduces mortality. The paper does not specifically state that MOUD reduces opioid-related overdose mortality; its mortality statements are broader or concern methadone supervision. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Studies in opioid use disorder have demonstrated poor patient adherence to oral naltrexone and failed to show any therapeutic impact of this drug on craving.

    “Consistent with this, studies in OUD have demonstrated poor patient adherence to oral naltrexone and failed to show any therapeutic impact of this drug on craving (105, 109, 123, 124).”

    From Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice (2019) · cites this paper as [105]

  • Relapse rates are higher in patients who undergo detoxification or receive psychosocial interventions alone.

    “Numerous studies have demonstrated that buprenorphine and methadone can reduce craving in OUD patients (108, 109), which may explain why relapse rates are higher in patients who undergo detoxification or receive psychosocial interventions alone (105).”

    From Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice (2019) · cites this paper as [105]

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 14

  1. World Health Organization, 2009, Global health risks: mortality and burden of disease attributable to selected major risks
  2. Salomon N, 2000, Int J Tuberc Lung Dis, 4, 47
  3. Centers for Disease Control and Prevention, 2011, MMRW, 60, 1487
  4. Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug Use and Health: summary of national findings
  5. Pescor M J, 1943, Publ Health Rep, 170, 1
  6. Mayet S, 2005, Cochrane Database Syst Rev
  7. Mattick R P, 2003, Cochrane Database Syst Rev
  8. Amato L, 2005, Cochrane Database Syst Rev
  9. Kleiderer E C, 1945, Pharmaceutical activities at the I.G. Farbenindustrie plant, Hochst am Main. 981
  10. Pfohl D N, 1986, NIDA Res Monogr, 67, 66
  11. Volavka J, 1976, Biol Psychiatry, 11, 679
  12. National Institutes of Health, 1976, Narcotic antagonists: naltrexone progress report
  13. Volpicelli J R, 1995, J Clin Psychiatry, 56, 39
  14. Ling W, 1984, J Clin Psychiatry, 45, 46

Cited by

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Related

Authors
Bart, G.
Affiliations
University of Minnesota (US)
Corresponding author
Bart, Gavin
ORCID
Bart, Gavin
Venue
Journal of Addictive Diseases
Publisher
Informa UK Limited
Published
2012-07
Volume
31
Issue
3
Pages
207-225
ISSN
  • 1055-0887 (ISSN-L)
  • 1545-0848
DOI
10.1080/10550887.2012.694598
PMC
PMC3411273
OpenAlex
W2088639396
Semantic Scholar
ff99fbcbbfa09ac397c39aa742621c60880a669f
Cited by
461
References
147
Citations by year
2026: 10 · 2025: 16 · 2024: 23 · 2023: 33 · 2022: 35 · 2021: 47 · 2020: 63 · 2019: 48 · 2018: 46 · 2017: 28 · 2016: 33 · 2015: 36 · 2014: 28 · 2013: 15
FWCI
24.39
Type
journal article
Language
en
Open access
Locations
  • Journal of Addictive Diseases (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Drug Abuse (K23DA024663)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords
opioid use disorder, maintenance therapy, methadone, buprenorphine, naltrexone, medication-assisted treatment, treatment retention, relapse, craving, drug selection
MeSH terms
Analgesics, Opioid, Buprenorphine, Humans, Long-Term Care, Methadone, Naltrexone, Narcotic Antagonists, Opioid-Related Disorders, Substance Withdrawal Syndrome, Treatment Outcome, Opiate Substitution Treatment

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

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