Authors: Kunøe, Nikolaj; Lobmaier, Philipp¹; Vederhus, John Kåre²; Hjerkinn, Bjørg²; Gossop, Michael³; Hegstad, Solfrid⁴; Kristensen, Øistein²; Waal, Helge¹

Source: Addiction, Volume 105, Number 9, September 2010 , pp. 1633-1639(7)

Publisher: Wiley-Blackwell

Abstract:

Aims 

Naltrexone is a competitive opioid antagonist that effectively blocks the action of heroin and other opioid agonists. Sustained-release naltrexone formulations are now available that provide long-acting opioid blockade. This study investigates the use of heroin and other opioids among opioid-dependent patients receiving treatment with long-acting naltrexone implants, their subjective experience of drug `high' after opioid use, and factors associated with opioid use. Methods 

Participants (n = 60) were opioid-dependent patients receiving treatment with naltrexone implants. Outcome data on substance use, drug `high', depression and criminal activity were collected over a 6-month period. Blood samples were taken to monitor naltrexone plasma levels, and hair samples to verify self-reported opioid use. Findings 

More than half [n = 34 or 56%; 95% confidence interval (CI) 44-68%)] the patients challenged the blockade with illicit opioids during the 6-month treatment period; 44% (n = 26; 95% CI 32-56%) were abstinent from opioids. Mean opioid use was reduced from 18 [standard deviation (SD)13] days during the month preceding treatment to 6 days (SD 11) after 6 months. Of the respondents questioned on opioid `high' (n = 31), nine patients (30%; 95% CI 16-47%) reported partial drug `high' following illicit opioid use, and three (12%; 95% CI 3-26%) reported full `high'. Opioid use was associated with use of non-opioid drugs and criminal behaviour. Conclusions 

Challenging naltrexone blockade with heroin on at least one occasion is common among sustained-release naltrexone patients, but only a minority of patients use opioids regularly. Challenges represent a warning sign for poor outcomes and often occur in the context of polydrug use and social adjustment problems.

Keywords: Clinical trial; drug euphoria; naltrexone; opioid antagonists; opioid dependent

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1360-0443.2010.03031.x

Affiliations: 1: SERAF, Norwegian Centre for Addiction Research, Kirkeveien 166, 0407 Oslo, Norway, 2: The Addiction Unit, Sørlandet Hospital, Serviceboks 416, 4604 Kristiansand, Norway, 3: National Addiction Centre, King's College, London, UK and 4: Division of Forensic Toxicology and Drug Abuse, the Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403 Oslo, Norway,

Publication date: 2010-09-01

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