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Problem drinking and low-dose naltrexone-assisted opioid detoxification.

Publication ,  Journal Article
Mannelli, P; Peindl, K; Patkar, AA; Wu, L-T; Tharwani, HM; Gorelick, DA
Published in: J Stud Alcohol Drugs
May 2011

OBJECTIVE: The influence of alcohol use on opioid dependence is a major problem that warrants a search for more effective treatment strategies. The addition of very-low-dose naltrexone (VLNTX) to methadone taper was recently associated with reduced withdrawal intensity during detoxification. In a secondary analysis of these data, we sought to determine whether problem drinking affects detoxification outcomes and whether symptoms are influenced by VLNTX use. METHOD: Opioid-dependent patients (N = 174) received naltrexone (0.125 or 0.250 mg/day) or placebo in a double-blind, randomized design during methadone-based, 6-day inpatient detoxification. Alcohol consumption was assessed at admission using the Addiction Severity Index and selfreport. Outcome measures were opioid withdrawal intensity, craving, and retention in treatment. RESULTS: Problem drinking-opioid dependent patients (n = 79) showed episodic heavy alcohol use and reported increased subjective opioid withdrawal intensity (p = .001), craving (p = .001), and significantly lower rate of retention in treatment (p = .02). Individuals with problem drinking and opioid dependence who were treated with VLNTX (n = 55) showed reduced withdrawal (p = .05) and a lower rate of treatment discontinuation (p = .03), resuming alcohol intake in smaller numbers the day following discharge (p = .03). Treatment effects were more pronounced on anxiety, perspiration, shakiness, nausea, stomach cramps, and craving. There were no group differences in use of adjuvant medications and no treatment-related adverse events. CONCLUSIONS: Heavy drinking is associated with worse opioid detoxification outcomes. The addition of VLNTX is safe and is associated with reduced withdrawal symptoms and better completion rate in these patients. Further studies should explore the use of VLNTX in detoxification and long-term treatment of combined alcohol-opioid dependence and alcohol dependence alone.

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Published In

J Stud Alcohol Drugs

DOI

EISSN

1938-4114

Publication Date

May 2011

Volume

72

Issue

3

Start / End Page

507 / 513

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Substance Withdrawal Syndrome
  • Substance Abuse
  • Severity of Illness Index
  • Opioid-Related Disorders
  • Opiate Substitution Treatment
  • Narcotic Antagonists
  • Naltrexone
  • Methadone
 

Citation

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Mannelli, P., Peindl, K., Patkar, A. A., Wu, L.-T., Tharwani, H. M., & Gorelick, D. A. (2011). Problem drinking and low-dose naltrexone-assisted opioid detoxification. J Stud Alcohol Drugs, 72(3), 507–513. https://doi.org/10.15288/jsad.2011.72.507
Mannelli, Paolo, Kathleen Peindl, Ashwin A. Patkar, Li-Tzy Wu, Haresh M. Tharwani, and David A. Gorelick. “Problem drinking and low-dose naltrexone-assisted opioid detoxification.J Stud Alcohol Drugs 72, no. 3 (May 2011): 507–13. https://doi.org/10.15288/jsad.2011.72.507.
Mannelli P, Peindl K, Patkar AA, Wu L-T, Tharwani HM, Gorelick DA. Problem drinking and low-dose naltrexone-assisted opioid detoxification. J Stud Alcohol Drugs. 2011 May;72(3):507–13.
Mannelli, Paolo, et al. “Problem drinking and low-dose naltrexone-assisted opioid detoxification.J Stud Alcohol Drugs, vol. 72, no. 3, May 2011, pp. 507–13. Pubmed, doi:10.15288/jsad.2011.72.507.
Mannelli P, Peindl K, Patkar AA, Wu L-T, Tharwani HM, Gorelick DA. Problem drinking and low-dose naltrexone-assisted opioid detoxification. J Stud Alcohol Drugs. 2011 May;72(3):507–513.

Published In

J Stud Alcohol Drugs

DOI

EISSN

1938-4114

Publication Date

May 2011

Volume

72

Issue

3

Start / End Page

507 / 513

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Substance Withdrawal Syndrome
  • Substance Abuse
  • Severity of Illness Index
  • Opioid-Related Disorders
  • Opiate Substitution Treatment
  • Narcotic Antagonists
  • Naltrexone
  • Methadone