TY - JOUR
KW - Administration, Oral
KW - Adolescent
KW - Adult
KW - Ambulatory Care
KW - Behavior Therapy
KW - Buprenorphine/administration & dosage
KW - Clonidine/administration & dosage
KW - Combined Modality Therapy
KW - Delayed-Action Preparations
KW - Dose-Response Relationship, Drug
KW - Drug Therapy, Combination
KW - Female
KW - Humans
KW - Injections, Intramuscular
KW - Male
KW - Middle Aged
KW - Naltrexone/administration & dosage
KW - Opioid-Related Disorders/rehabilitation
KW - Remission Induction
KW - Secondary prevention
KW - Young Adult
KW - buprenorphine
KW - Detoxification
KW - Injectable naltrexone
KW - Naltrexone
KW - opioid dependence
KW - Outpatient
AU - Maria Sullivan
AU - Adam Bisaga
AU - Martina Pavlicova
AU - Jean Choi
AU - Kaitlyn Mishlen
AU - Kenneth M. Carpenter
AU - Frances R. Levin
AU - Elias Dakwar
AU - John J. Mariani
AU - Edward V. Nunes
A1 - 
AB - OBJECTIVE: At present there is no established optimal approach for transitioning opioid-dependent adults to extended-release injection naltrexone (XR-naltrexone) while preventing relapse. The authors conducted a trial examining the efficacy of two methods of outpatient opioid detoxification for induction to XR-naltrexone. METHOD: Participants were 150 opioid-dependent adults randomly assigned 2:1 to one of two outpatient detoxification regimens, naltrexone-assisted detoxification or buprenorphine-assisted detoxification, followed by an injection of XR-naltrexone. Naltrexone-assisted detoxification lasted 7 days and included a single day of buprenorphine followed by ascending doses of oral naltrexone along with clonidine and other adjunctive medications. Buprenorphine-assisted detoxification included a 7-day buprenorphine taper followed by a week-long delay before administration of XR-naltrexone, consistent with official prescribing information for XR-naltrexone. Participants from both groups received behavioral therapy focused on medication adherence and a second dose of XR-naltrexone. RESULTS: Compared with participants in the buprenorphine-assisted detoxification condition, participants assigned to naltrexone-assisted detoxification were significantly more likely to be successfully inducted to XR-naltrexone (56.1% compared with 32.7%) and to receive the second injection at week 5 (50.0% compared with 26.9%). Both models adjusted for primary type of opioid use, route of opioid administration, and morphine equivalents at baseline. CONCLUSIONS: These results demonstrate the safety, efficacy, and tolerability of low-dose naltrexone, in conjunction with single-day buprenorphine dosing and adjunctive nonopioid medications, for initiating adults with opioid dependence to XR-naltrexone. This strategy offers a promising alternative to the high rates of attrition and relapse currently observed with agonist tapers in both inpatient and outpatient settings.
AD - From the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York; New York State Psychiatric Institute, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York; and Alkermes, Waltham, Mass.; From the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York; New York State Psychiatric Institute, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York; and Alkermes, Waltham, Mass.; From the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York; New York State Psychiatric Institute, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York; and Alkermes, Waltham, Mass.; From the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York; New York State Psychiatric Institute, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York; and Alkermes, Waltham, Mass.; From the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York; New York State Psychiatric Institute, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York; and Alkermes, Waltham, Mass.; From the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York; New York State Psychiatric Institute, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York; and Alkermes, Waltham, Mass.; From the Department of Psychiatry, College of Physicians and Surgeons(TRUNCATED)
BT - The American Journal of Psychiatry
C5 - Opioids & Substance Use
CP - 5
CY - United States
DO - 10.1176/appi.ajp.2016.16050548
IS - 5
JF - The American Journal of Psychiatry
LA - eng
M1 - Journal Article
N2 - OBJECTIVE: At present there is no established optimal approach for transitioning opioid-dependent adults to extended-release injection naltrexone (XR-naltrexone) while preventing relapse. The authors conducted a trial examining the efficacy of two methods of outpatient opioid detoxification for induction to XR-naltrexone. METHOD: Participants were 150 opioid-dependent adults randomly assigned 2:1 to one of two outpatient detoxification regimens, naltrexone-assisted detoxification or buprenorphine-assisted detoxification, followed by an injection of XR-naltrexone. Naltrexone-assisted detoxification lasted 7 days and included a single day of buprenorphine followed by ascending doses of oral naltrexone along with clonidine and other adjunctive medications. Buprenorphine-assisted detoxification included a 7-day buprenorphine taper followed by a week-long delay before administration of XR-naltrexone, consistent with official prescribing information for XR-naltrexone. Participants from both groups received behavioral therapy focused on medication adherence and a second dose of XR-naltrexone. RESULTS: Compared with participants in the buprenorphine-assisted detoxification condition, participants assigned to naltrexone-assisted detoxification were significantly more likely to be successfully inducted to XR-naltrexone (56.1% compared with 32.7%) and to receive the second injection at week 5 (50.0% compared with 26.9%). Both models adjusted for primary type of opioid use, route of opioid administration, and morphine equivalents at baseline. CONCLUSIONS: These results demonstrate the safety, efficacy, and tolerability of low-dose naltrexone, in conjunction with single-day buprenorphine dosing and adjunctive nonopioid medications, for initiating adults with opioid dependence to XR-naltrexone. This strategy offers a promising alternative to the high rates of attrition and relapse currently observed with agonist tapers in both inpatient and outpatient settings.
PP - United States
PY - 2017
SN - 1535-7228; 0002-953X
SP - 459
EP - 467
EP - 
T1 - Long-Acting Injectable Naltrexone Induction: A Randomized Trial of Outpatient Opioid Detoxification With Naltrexone Versus Buprenorphine
T2 - The American Journal of Psychiatry
TI - Long-Acting Injectable Naltrexone Induction: A Randomized Trial of Outpatient Opioid Detoxification With Naltrexone Versus Buprenorphine
U1 - Opioids & Substance Use
U2 - 28068780
U3 - 10.1176/appi.ajp.2016.16050548
VL - 174
VO - 1535-7228; 0002-953X
Y1 - 2017
Y2 - May 1
ER -