Opioid Detoxification and Naltrexone Induction Strategies: Recommendations for Clinical Practice
- 12 March 2012
- journal article
- research article
- Published by Taylor & Francis Ltd in The American Journal of Drug and Alcohol Abuse
- Vol. 38 (3), 187-199
- https://doi.org/10.3109/00952990.2011.653426
Abstract
Background: Opioid dependence is a significant public health problem associated with high risk for relapse if treatment is not ongoing. While maintenance on opioid agonists (i.e., methadone, buprenorphine) often produces favorable outcomes, detoxification followed by treatment with the μ-opioid receptor antagonist naltrexone may offer a potentially useful alternative to agonist maintenance for some patients. Method: Treatment approaches for making this transition are described here based on a literature review and solicitation of opinions from several expert clinicians and scientists regarding patient selection, level of care, and detoxification strategies. Conclusion: Among the current detoxification regimens, the available clinical and scientific data suggest that the best approach may be using an initial 2–4 mg dose of buprenorphine combined with clonidine, other ancillary medications, and progressively increasing doses of oral naltrexone over 3–5 days up to the target dose of naltrexone. However, more research is needed to empirically validate the best approach for making this transition.Keywords
This publication has 98 references indexed in Scilit:
- The association between outpatient buprenorphine detoxification duration and clinical treatment outcomes: A reviewDrug and Alcohol Dependence, 2011
- A placebo controlled trial of memantine as an adjunct to oral naltrexone for opioid dependenceDrug and Alcohol Dependence, 2011
- Use of Naltrexone to Treat Opioid Addiction in a Country in Which Methadone and Buprenorphine Are Not AvailableCurrent Psychiatry Reports, 2010
- A multi-site, two-phase, Prescription Opioid Addiction Treatment Study (POATS): Rationale, design, and methodologyContemporary Clinical Trials, 2010
- A randomized clinical trial of methadone maintenance for prisoners: Results at 12 months postreleaseJournal of Substance Abuse Treatment, 2009
- Brief buprenorphine detoxification for the treatment of prescription opioid dependence: A pilot studyAddictive Behaviors, 2009
- Predictors of outcome for short-term medically supervised opioid withdrawal during a randomized, multicenter trial of buprenorphine–naloxone and clonidine in the NIDA clinical trials network drug and alcohol dependenceDrug and Alcohol Dependence, 2009
- A Phase 3 placebo-controlled, double-blind, multi-site trial of the alpha-2-adrenergic agonist, lofexidine, for opioid withdrawalDrug and Alcohol Dependence, 2008
- Cellular neuroadaptations to chronic opioids: tolerance, withdrawal and addictionBritish Journal of Pharmacology, 2008
- Release from Prison — A High Risk of Death for Former InmatesThe New England Journal of Medicine, 2007