Article

Maintenance treatment with buprenorphine and naltrexone for heroin dependence in Malaysia: a randomised, double-blind, placebo-controlled trial.

Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
The Lancet (Impact Factor: 39.21). 07/2008; 371(9631):2192-200. DOI: 10.1016/S0140-6736(08)60954-X
Source: PubMed

ABSTRACT Expansion of access to effective treatments for heroin dependence is a worldwide health priority that will also reduce HIV transmission. We compared the efficacy of naltrexone, buprenorphine, and no additional treatment, in patients receiving detoxification and subsequent drug counselling, for maintenance of heroin abstinence, prevention of relapse, and reduction of HIV risk behaviours.
126 detoxified heroin-dependent patients, from an outpatient research clinic and detoxification programme in Malaysia, were randomly assigned by a computer-generated randomisation sequence to 24 weeks of manual-guided drug counselling and maintenance with naltrexone (n=43), buprenorphine (n=44), or placebo (n=39). Medications were administered on a double-blind and double-dummy basis. Primary outcomes, assessed by urine testing three times per week, were days to first heroin use, days to heroin relapse (three consecutive opioid-positive urine tests), maximum consecutive days of heroin abstinence, and reductions in HIV risk behaviours over 6 months. The study was terminated after 22 months of enrolment because buprenorphine was shown to have greater efficacy in an interim safety analysis. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00383045.
We observed consistent, linear contrasts in days to first heroin use (p=0.0009), days to heroin relapse (p=0.009), and maximum consecutive days abstinent (p=0.0007), with all results best for buprenorphine and worst for placebo. Buprenorphine was associated with greater time to first heroin use than were naltrexone (hazard ratio 1.87 [95% CI 1.21-2.88]) or placebo (2.02 [1.29-3.16]). With buprenorphine, we also recorded significantly greater time to heroin relapse (2.17 [1.38-3.42]), and maximum consecutive days abstinent than with placebo (mean days 59 [95% CI 43-76] vs 24 [13-35]; p=0.003); however, for these outcomes, differences between buprenorphine and naltrexone were not significant. Differences between naltrexone and placebo were not significant for any outcomes. HIV risk behaviours were significantly reduced from baseline across all three treatments (p=0.003), but the reductions did not differ significantly between the three groups.
Our findings lend support to the widespread dissemination of maintenance treatment with buprenorphine as an effective public-health approach to reduce problems associated with heroin dependence.

Full-text

Available from: Marek C Chawarski, Aug 27, 2014
0 Followers
 · 
92 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this article is to review current empirical research on the effectiveness of drug treatment programs, particularly those for prisoners, parolees, and probationers. The authors reviewed empirical research published after the year 2000 that they classified as Level 3 or higher on the Maryland Scale. Participants in cognitive-behavioral therapy (CBT), therapeutic communities, and drug courts had lower rates of drug use and crime than comparable individuals who did not receive treatment. Several different types of pharmacological treatments were associated with a reduced frequency of drug use. Those who received contingency management tended to use drugs less frequently, particularly if they also received cognitive-behavioral therapy. Finally, researchers reported that drug use and crime were lower among individuals whose treatment was followed by an aftercare program. Effective treatment programs tend to (a) focus on high-risk offenders, (b) provide strong inducements to receive treatment, (c) include several different types of interventions simultaneously, (d) provide intensive treatment, and (e) include an aftercare component.
    The Prison Journal 06/2012; 92(2):155-174. DOI:10.1177/0032885512438836 · 0.40 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction & Aim: To evaluate in a real-world setting the short-term outcome among opioid-dependent patients receiving take-home medications. Methods: A total of 102 opioid-dependent patients who formed part of this study received either naltrexone or buprenorphine as long-term treatment for relapse prevention. Following the initiation of treatment in a hospital-based setting, a family member supervised the treatment at home. Measurements included assessment of demographic and clinical variables, retention in treatment, drug use at baseline and follow-up. Results: Majority of patients (69, 67.6%) were dependent on pharmaceutical opioids. Thirty-two (32%) received naltrexone and 70 (68%) were put on buprenorphine maintenance treatment. Followup information was available for 67.5% for 3 months, 63% for 6 months and 58% for 1 year. At the end of 6 months, 40% patients were abstinent. This rate decreased to 37.8% at the end of 1 year. Discussion & Conclusions: Buprenorphine was found to be more effective with greater retention rates compared with naltrexone (68% vs. 42%). Buprenorphine maintenance was also found to be useful for patients with pharmaceutical opioid dependence.
    Journal of Substance Use 04/2013; 18(2):108-118. DOI:10.3109/14659891.2011.615882 · 0.48 Impact Factor
  • The International journal on drug policy 01/2014; 25(3). DOI:10.1016/j.drugpo.2014.01.006 · 2.54 Impact Factor