Background
Oral naltrexone effectively antagonizes heroin, but patient noncompliance limits its
utility; sustained-release preparations may overcome this. Few data are available
on optimal blood naltrexone levels for preventing craving and/or return to heroin
use. This study assesses various risk factors, including blood naltrexone level, for
heroin craving and relapse to illicit opioids.
Methods
Heroin-dependent persons from a randomized controlled trial of oral versus implant
naltrexone were followed up for 6 months. Thirty-four participants received 50 mg
oral naltrexone daily, plus placebo implant; thirty-five participants received a single
dose of 2.3 g naltrexone implant, plus daily oral placebo tablets.
Results
Compared to oral naltrexone patients, implant naltrexone patients were significantly
less likely to use any opioids and had one-fifth the risk of using heroin ≥ weekly.
Risk of ≥ weekly heroin use increased by 2.5 times at blood naltrexone concentration
< .5 ng/mL compared with ≥ .5 ng/mL, with 3 ng/mL associated with very low risk of
use. Craving remained near “floor” levels for implant patients but rebounded to higher
levels among oral patients. Lower craving scores (≤ 20/70) predicted lower relapse
risk. Noncompliance with daily oral formula, higher baseline craving, longer history
of use, and being younger predicted higher craving at follow-up.
Conclusions
Implant naltrexone was better associated with reduced heroin craving and relapse than
oral naltrexone. Effective treatment was achieved at blood naltrexone levels of 1
ng/mL to 3 ng/mL, with higher levels associated with greater efficacy. Craving assessment
may be valuable in predicting relapse risk allowing timely intervention.
Key Words
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Article info
Publication history
Published online: May 31, 2010
Accepted:
April 7,
2010
Received in revised form:
April 5,
2010
Received:
August 10,
2009
Identification
Copyright
© 2010 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
