Risk factors for craving and relapse in heroin users treated with oral or implant naltrexone
Background: Oral naltrexone effectively antagonizes heroin, but patient noncompliance limits its utility; sustained-release preparations may overcome this. Few data are available on optimal blood naltrexone levels for preventing craving and/or return to heroin use. This study assesses various risk f...
| Main Authors: | , , |
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| Format: | Journal Article |
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Elsevier Inc.
2010
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| Online Access: | http://hdl.handle.net/20.500.11937/5417 |
| _version_ | 1848744790762455040 |
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| author | Hulse, G. Ngo, H. Tait, Robert |
| author_facet | Hulse, G. Ngo, H. Tait, Robert |
| author_sort | Hulse, G. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background: Oral naltrexone effectively antagonizes heroin, but patient noncompliance limits its utility; sustained-release preparations may overcome this. Few data are available on optimal blood naltrexone levels for preventing craving and/or return to heroin use. This study assesses various risk factors, including blood naltrexone level, for heroin craving and relapse to illicit opioids. Methods: Heroin-dependent persons from a randomized controlled trial of oral versus implant naltrexone were followed up for 6 months. Thirty-four participants received 50 mg oral naltrexone daily, plus placebo implant; thirty-five participants received a single dose of 2.3 g naltrexone implant, plus daily oral placebo tablets. Results: Compared to oral naltrexone patients, implant naltrexone patients were significantly less likely to use any opioids and had one-fifth the risk of using heroin = weekly. Risk of = weekly heroin use increased by 2.5 times at blood naltrexone concentration < .5 ng/mL compared with < .5 ng/mL, with 3 ng/mL associated with very low risk of use. Craving remained near "floor" levels for implant patients but rebounded to higher levels among oral patients. Lower craving scores (= 20/70) predicted lower relapse risk. Noncompliance with daily oral formula, higher baseline craving, longer history of use, and being younger predicted higher craving at follow-up. Conclusions: Implant naltrexone was better associated with reduced heroin craving and relapse than oral naltrexone. Effective treatment was achieved at blood naltrexone levels of 1 ng/mL to 3 ng/mL, with higher levels associated with greater efficacy. Craving assessment may be valuable in predicting relapse risk allowing timely intervention. © 2010 Society of Biological Psychiatry. |
| first_indexed | 2025-11-14T06:07:04Z |
| format | Journal Article |
| id | curtin-20.500.11937-5417 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T06:07:04Z |
| publishDate | 2010 |
| publisher | Elsevier Inc. |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-54172017-09-13T14:38:33Z Risk factors for craving and relapse in heroin users treated with oral or implant naltrexone Hulse, G. Ngo, H. Tait, Robert Background: Oral naltrexone effectively antagonizes heroin, but patient noncompliance limits its utility; sustained-release preparations may overcome this. Few data are available on optimal blood naltrexone levels for preventing craving and/or return to heroin use. This study assesses various risk factors, including blood naltrexone level, for heroin craving and relapse to illicit opioids. Methods: Heroin-dependent persons from a randomized controlled trial of oral versus implant naltrexone were followed up for 6 months. Thirty-four participants received 50 mg oral naltrexone daily, plus placebo implant; thirty-five participants received a single dose of 2.3 g naltrexone implant, plus daily oral placebo tablets. Results: Compared to oral naltrexone patients, implant naltrexone patients were significantly less likely to use any opioids and had one-fifth the risk of using heroin = weekly. Risk of = weekly heroin use increased by 2.5 times at blood naltrexone concentration < .5 ng/mL compared with < .5 ng/mL, with 3 ng/mL associated with very low risk of use. Craving remained near "floor" levels for implant patients but rebounded to higher levels among oral patients. Lower craving scores (= 20/70) predicted lower relapse risk. Noncompliance with daily oral formula, higher baseline craving, longer history of use, and being younger predicted higher craving at follow-up. Conclusions: Implant naltrexone was better associated with reduced heroin craving and relapse than oral naltrexone. Effective treatment was achieved at blood naltrexone levels of 1 ng/mL to 3 ng/mL, with higher levels associated with greater efficacy. Craving assessment may be valuable in predicting relapse risk allowing timely intervention. © 2010 Society of Biological Psychiatry. 2010 Journal Article http://hdl.handle.net/20.500.11937/5417 10.1016/j.biopsych.2010.04.003 Elsevier Inc. restricted |
| spellingShingle | Hulse, G. Ngo, H. Tait, Robert Risk factors for craving and relapse in heroin users treated with oral or implant naltrexone |
| title | Risk factors for craving and relapse in heroin users treated with oral or implant naltrexone |
| title_full | Risk factors for craving and relapse in heroin users treated with oral or implant naltrexone |
| title_fullStr | Risk factors for craving and relapse in heroin users treated with oral or implant naltrexone |
| title_full_unstemmed | Risk factors for craving and relapse in heroin users treated with oral or implant naltrexone |
| title_short | Risk factors for craving and relapse in heroin users treated with oral or implant naltrexone |
| title_sort | risk factors for craving and relapse in heroin users treated with oral or implant naltrexone |
| url | http://hdl.handle.net/20.500.11937/5417 |