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
 · 
99 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Over the past decade, the amount and variety of addiction research around the world has increased substantially. Researchers in Australia, Canada, United Kingdom, United States, and western Europe have significantly contributed to knowledge about addiction and its treatment. However, the nature and context of substance use disorders and the populations using drugs are far more diverse than is reflected in studies done in Western cultures. To stimulate new research from a diverse set of cultural perspectives, the National Institute on Drug Abuse (NIDA) has promoted the development of addiction research capacity and skills around the world for over 25 years. This review will describe the programs NIDA has developed to sponsor international research and research fellows and will provide some examples of the work NIDA has supported. NIDA fellowships have allowed 496 individuals from 96 countries to be trained in addiction research. The United Arab Emirates and Saudi Arabia have recently developed funding to support addiction research to study, with advice from NIDA, the substance use disorder problems that affect their societies. Examples from Malaysia, Tanzania, Brazil, Russian Federation, Ukraine, Republic of Georgia, Iceland, China, and Vietnam are used to illustrate research being conducted with NIDA support. Health services research, collaboratively funded by the U.S. National Institutes of Health and Department of State, addresses a range of addiction service development questions in low- and middle-income countries. Findings have expanded the understanding of addiction and its treatment, and are enhancing the ability of practitioners and policy makers to address substance use disorders.
    Harvard Review of Psychiatry 03/2015; 23(2):147-56. DOI:10.1097/HRP.0000000000000067 · 2.49 Impact Factor
  • The International journal on drug policy 01/2014; 25(3). DOI:10.1016/j.drugpo.2014.01.006 · 2.54 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