Maintenance Medication for Opiate Addiction: The Foundation of Recovery

In the paper

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

What the sources say

• Not checked yetcites [36] Pescor M J, 1943, Publ Health Rep
• Not checked yetcites [37] Vaillant G E, 1973, Arch Gen Psychiatry source

In the paper

“Oral naltrexone is ineffective in treating opiate addiction but recent studies using extended release naltrexone injections have shown promise.”

What the sources say

• Not checked yetcites [117] Comer S D, 2006, Arch Gen Psychiatry source
• Not checked yetcites [118] Krupitsky E, 2011, Lancet source

In the paper

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

In the paper

“when used alone, these approaches should be considered to lie outside the domain of first-line evidence based treatment”

In the paper

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

In the paper

“The risk for developing opiate addiction is a complex interaction between genetics, environmental factors, and the pharmacological effects of opiates.”

What the sources say

• Not checked yetcites [13] Kreek M J, 2005, Pharmacol Rev source
• Not checked yetcites [14] Merikangas K R, 1998, Arch Gen Psychiatry source
• Not checked yetcites [15] Tsuang M T, 1998, Arch Gen Psychiatry source

In the paper

“Results indicate that maintenance medication provides the best opportunity for patients to achieve recovery from opiate addiction.”

In the paper

“Oral naltrexone is ineffective in treating opiate addiction but recent studies using extended release naltrexone injections have shown promise.”

What the sources say

• Not checked yetcites [116]

In the paper

“Similarly poor results are seen with medication assisted detoxification.”

What the sources say

• Not checked yetcites [48] Sees K L, 2000, JAMA source
• Not checked yetcites [49] Ling W, 2009, Addiction source

In the paper

“Treatment for opiate addiction requires long-term management.”

In the paper

“While no direct comparisons between extended release naltrexone injections and either methadone or buprenorphine exist”

In the paper

“The short term (first 30 days) effect on relief of symptoms and return to illicit opiate use between alpha adrenergic agonists such as clonidine and lofexidine (and presumably dexmedetomidine) and opiate based regimens are similar.”

What the sources say

• Not checked yetcites [45] Amato L, 2005, Cochrane Database Syst Rev

In the paper

“Naltrexone safety is well established.”

What the sources say

• Not checked yetcites [108] Pfohl D N, 1986, NIDA Res Monogr

In the paper

“Methadone safety is well established.”

What the sources say

• Not checked yetcites [52] Kreek M J, 1973, JAMA source

In the paper

“Longer period of detoxification (1–6 months) with methadone or buprenorphine are also ineffective in promoting abstinence beyond the initial stabilization period.”

What the sources say

• Not checked yetcites [48] Sees K L, 2000, JAMA source
• Not checked yetcites [49] Ling W, 2009, Addiction source

In the paper

“naltrexone can block the effect of superimposed opiates for approximately 24–48 hours after oral dosing”

What the sources say

• Not checked yetcites [110] Volavka J, 1976, Biol Psychiatry

In the paper

“phase III research reports indicate that buprenorphine maintenance is quite safe with equivalent adverse events to methadone and placebo”

What the sources say

• Not checked yetcites [64] Johnson R E, 2000, N Engl J Med source
• Not checked yetcites [66] Ling W, 1996, Arch Gen Psychiatry source
• Not checked yetcites [83] Fudala P J, 2003, N Engl J Med source

In the paper

“A Cochrane collaboration meta-analysis found that due to extensive drop-out rates, oral naltrexone maintenance with or without psychotherapy was no better than placebo treatment.”

What the sources say

• Not checked yetcites [116]

In the paper

“When adequate doses are used, treatment outcome in terms of retention and reduction in illicit opiate use is similar to that of methadone maintenance.”

What the sources say

• Not checked yetcites [95] Mattick, R P, Kimber, J, Breen, C and Davoli, M. “Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence”. Cochrane Database Syst Rev 2008 CD002207 source

In the paper

“following steady-state oral administration, naltrexone achieves approximately 95% mu opioid receptor occupancy”

What the sources say

• Not checked yetcites [122] Weerts E M, 2008, Neuropsychopharmacology source

In the paper

“Like other opiate agonists, methadone has the potential to induce lethal respiratory suppression when given in doses that exceed an individual’s tolerance.”

In the paper

“A comparative study between buprenorphine and oral naltrexone found naltrexone response inferior.130”

What the sources say

• Not checked yetcites [130] Schottenfeld R S, 2008, Lancet source

In the paper

“A larger trial in Russia retained 53% of patients at 6 months compared to 38% for placebo.”

What the sources say

• Not checked yetcites [118] Krupitsky E, 2011, Lancet source

In the paper

“Patients receiving extended release naltrexone also had significantly fewer days of illicit opiate use.”

What the sources say

• Not checked yetcites [118] Krupitsky E, 2011, Lancet source

In the paper

“It has been observed that the 6-month retention rates following extended release naltrexone are similar to 1-year retentions in methadone maintenance and thus non-inferiority studies of extended release naltrexone are needed.131”

What the sources say

• Not checked yetcites [131] Bart G, 2011, Lancet source

In the paper

“Patient adherence and drop out has been a major stumbling block for oral naltrexone.”

What the sources say

• Not checked yetcites [113] O’Brien C P, 1975, Am J Drug Alcohol Abuse source
• Not checked yetcites [114] Hollister L E, 1977, Drug Alcohol Depend source
• Not checked yetcites [115] Judson B A, 1981, Drug Alcohol Depend source

In the paper

“the role of buprenorphine in the treatment of opiate addiction is not simply replacement of an illicitly used opiate for a medically supervised opiate but rather as a medication that corrects many of the neurobiological processes contributing to relapse”

In the paper

“Extended release naltrexone may improve treatment outcome because non-adherence to daily oral regimens is reduced by delivery of a once monthly injection.”

In the paper

“it may more importantly be thought of as a relapse prevention drug in that it normalizes many of the physiological stress-related responses that precede and contribute to relapse”

In the paper

“is associated with decreased drug use”

In the paper

“methadone and buprenorphine appear to have superior outcomes to both oral and intramuscular naltrexone”

In the paper

“A significant number of patients in maintenance pharmacotherapy complain of chronic pain.137”

What the sources say

• Not checked yetcites [137] Rosenblum A, 2003, JAMA source

In the paper

“Thus, these medications help patients achieve “recovery” as it is currently defined.147”

What the sources say

• Not checked yetcites [147] What is recovery?, 2007, J Subst Abuse Treat source

In the paper

“Increased retention reduces mortality”

In the paper

“improves social function”

In the paper

“there is legal precedent for compulsory addiction treatment and medication in offenders”

What the sources say

• Not checked yetcites [142] Richard J, 2006, Journal of Substance Abuse Treatment source

In the paper

“Behavioral interventions alone have retention rates approaching 80%.144”

What the sources say

• Not checked yetcites [144] Skipper G E, 2009, Anesth Analg source

In the paper

“Methadone and buprenorphine have been used with success in criminal justice populations.139,140”

What the sources say

• Not checked yetcites [139] Kinlock T W, 2009, J Subst Abuse Treat source
• Not checked yetcites [140] Magura S, 2009, Drug Alcohol Depend source

In the paper

“Early interventions can prevent the associated consequences of addiction such as HIV and hepatitis C.135”

What the sources say

• Not checked yetcites [135] Piccolo P, 2002, J Addict Dis source

In the paper

“Opiate addicted health professionals have excellent treatment outcomes compared to the general population.143”

What the sources say

• Not checked yetcites [143] Domino K B, 2005, JAMA source

In the paper

“there was lower retention in the buprenorphine treated group.”

What the sources say

• Not checked yetcites [134] Jones H E, 2010, N Engl J Med source

In the paper

“improved quality of life”

In the paper

“Oral naltrexone requires close supervision for adherence”

What the sources say

• Not checked yetcites [141] Coviello D M, 2010, Am J Addict source

In the paper

“Decreased hepatic metabolism and plasma protein can lead to increased methadone clearance.132”

What the sources say

• Not checked yetcites [132] Kreek M J, 1980, Biomed Mass Spectrom source