Treatment Research Institute, 600 Public Ledger Bldg, 150 S Independence Mall West, Philadelphia, PA 19106, USA.
J Clin Psychiatry. 2010 Oct;71(10):1371-8. doi: 10.4088/JCP.09m05080ecr. Epub 2010 Jul 13.
To conduct a quasi-experimental comparison of early clinical outcomes between injectable, sustained-release, depot naltrexone formulation versus oral naltrexone maintenance therapy in individuals with opiate dependence.
Early retention in treatment and urine-confirmed opiate use in the first 8 weeks postdetoxification were compared between patients (diagnosed as opiate-dependent according to DSM-IV criteria) participating in 2 concurrently run randomized clinical trials of oral (n = 69; patients treated from September 1999 to May 2002) and long-acting injectable (n = 42; patients treated from November 2000 to June 2003) naltrexone maintenance therapy with psychosocial therapy.
Long-acting injectable naltrexone produced significantly better outcome than oral naltrexone on days retained in treatment (F(1,106) = 6.49, P = .012) and for 1 measure of opiate use (F(1,106) = 5.26, P = .024); other measures were not significantly different, but differences were in the same direction. In subanalyses, there were interaction effects between baseline heroin use severity and type of treatment. In subanalyses, heroin users with more severe baseline use showed better retention with oral naltrexone maintenance therapy combined with intensive psychotherapy (behavioral naltrexone therapy) as compared to retention shown by severe heroin users treated with long-acting naltrexone injections combined with standard cognitive-behavioral therapy (χ²(1)= 9.31, P = .002); less severe heroin users evidenced better outcomes when treated with long-acting injectable naltrexone.
This quasi-experimental analysis provides tentative indications of superior outcomes for heroin-dependent patients treated with long-acting injectable naltrexone compared to oral naltrexone. The finding that heroin users with more severe baseline use achieved better outcomes with oral naltrexone is most probably attributable to the intensive nature of the psychosocial treatments provided and points to the opportunity for continued research in augmenting injectable naltrexone with psychosocial strategies to further improve outcome, especially in individuals with more severe use. The results should be considered exploratory given the quasi-experimental nature of the study.
在阿片类药物依赖个体中，对注射型、缓释、长效纳曲酮与口服纳曲酮维持治疗的早期临床结局进行准实验比较。
根据 DSM-IV 标准诊断为阿片类药物依赖的患者（n=111）参与了两项同时进行的随机临床试验，分别接受口服（n=69；患者于 1999 年 9 月至 2002 年 5 月接受治疗）和长效注射（n=42；患者于 2000 年 11 月至 2003 年 6 月接受治疗）纳曲酮维持治疗联合心理社会治疗。在脱毒后 8 周内，比较两组患者的早期治疗保留率和尿液证实的阿片类药物使用情况。
长效注射纳曲酮在治疗保留天数（F（1，106）=6.49，P=0.012）和 1 项阿片类药物使用测量指标（F（1，106）=5.26，P=0.024）上的疗效显著优于口服纳曲酮；其他测量指标无显著差异，但方向一致。在亚分析中，基线海洛因使用严重程度和治疗类型之间存在交互作用。亚分析结果显示，基线海洛因使用严重程度较高的患者，与严重海洛因使用者接受长效纳曲酮注射联合标准认知行为治疗相比，联合强化心理治疗的口服纳曲酮维持治疗保留率更高（χ²（1）=9.31，P=0.002）；基线海洛因使用程度较轻的患者接受长效注射纳曲酮治疗的效果更好。
这项准实验分析初步表明，与口服纳曲酮相比，长效注射纳曲酮治疗海洛因依赖患者的疗效更好。基线使用严重程度较高的海洛因使用者接受口服纳曲酮治疗效果更好，这可能归因于提供的心理社会治疗的强化性质，并表明有机会通过将心理社会策略与长效纳曲酮联合使用来进一步提高治疗效果，特别是在使用程度较严重的患者中。鉴于该研究的准实验性质，结果应被视为探索性的。
