Department of Psychology, University of Detroit Mercy , Detroit, MI, USA.
Division on Substance Use Disorders New York State Psychiatric Institute , New York, NY, USA.
Am J Drug Alcohol Abuse. 2020 May 3;46(3):289-296. doi: 10.1080/00952990.2019.1700265. Epub 2019 Dec 20.
Extended-release (XR) naltrexone can prevent relapse to opioid use disorder following detoxification. However, one of the barriers to initiating XR-naltrexone is the recommendation for a 7-10-day period of abstinence from opioids prior to the first dose.
The current study evaluated the feasibility of an XR-naltrexone induction protocol that can be implemented over 1 week in the outpatient clinic.
Participants (N = 44) were seen in the clinic daily. On Day 1, after abstaining from opioids for at least 12 h, they received buprenorphine 6-8 mg. Adjunctive medications (clonidine, clonazepam, zolpidem, trazodone, and prochlorperazine) were dispensed on Days 2-5, while ascending oral doses of naltrexone were given on Days 3-5 starting with 1 mg dose. An injection of XR-naltrexone was given on Day 5, 1 h after receiving and tolerating naltrexone 24 mg.
Of the 44 participants (38 males), 35 (80%) were heroin users and 9 (20%) used prescription opioids. A total of 26 participants (59%) completed the induction and received their first injection of XR-naltrexone. XR-naltrexone was initiated in 54% (19/35) of heroin users and 78% (7/9) of prescription opioid users.
The results support the feasibility of a week-long outpatient induction onto XR-naltrexone with ascending doses of naltrexone and standing doses of adjunctive medications. By circumventing the need for a protracted period of abstinence and mitigating the severity of withdrawal symptoms experienced during naltrexone titration, this strategy has the potential to increase patient acceptability and access to relapse prevention treatment with XR-naltrexone.
延长释放（XR）纳曲酮可以预防阿片类药物戒断后的药物使用障碍复发。然而，启动 XR-纳曲酮的一个障碍是建议在首次剂量前至少有 7-10 天的阿片类药物戒断期。
本研究评估了一种可在门诊环境中在 1 周内实施的 XR-纳曲酮诱导方案的可行性。
参与者（N=44）每天在诊所就诊。在第 1 天，在至少 12 小时不使用阿片类药物后，他们接受了 6-8 毫克的丁丙诺啡。在第 2-5 天，同时给予辅助药物（可乐定、氯硝西泮、唑吡坦、曲唑酮和丙氯拉嗪），而在第 3-5 天，每天递增口服纳曲酮剂量，起始剂量为 1 毫克。在第 5 天，在耐受纳曲酮 24 毫克 1 小时后，给予 XR-纳曲酮注射。
在 44 名参与者（38 名男性）中，35 名（80%）为海洛因使用者，9 名（20%）使用处方类阿片类药物。共有 26 名参与者（59%）完成了诱导治疗并接受了他们的第一剂 XR-纳曲酮。54%（19/35）的海洛因使用者和 78%（7/9）的处方类阿片使用者开始使用 XR-纳曲酮。
结果支持使用递增剂量的纳曲酮和固定剂量的辅助药物，在门诊环境中进行为期一周的 XR-纳曲酮诱导治疗的可行性。通过避免长期的戒断期并减轻纳曲酮滴定过程中经历的戒断症状的严重程度，这种策略有可能提高患者对 XR-纳曲酮预防复发治疗的接受度和可及性。
