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Predictors for retention in treatment with a UK community-based naltrexone programme for opioid dependence

  • Zubair A. Chaudhry (a1), Javaid Sultan (a2) and Farrukh Alam (a1)
Abstract
Aims and method

To evaluate the efficacy of naltrexone maintenance therapy in a community-based programme for opioid-dependent patients and to identify predictors for longer-term retention in treatment. A retrospective case-note study was conducted in 142 people dependent on opioids who had undergone detoxification and maintained adherence to naltrexone treatment for a minimum of 4 weeks. Social and clinical demographic factors during treatment were recorded using a standardised naltrexone monitoring scale. Efficacy was measured as retention in treatment, and potential predictors were examined using regression analysis.

Results

Although there was overall low retention of patients in treatment, 55.6% of the patients remained in treatment for 4–8 weeks, and 29.6% of the patients remained in treatment for 17 weeks or more. Enhanced long-term retention in treatment was associated with Asian or other minority ethnic status, employment, parental supervision of naltrexone administration, less boredom, short duration of addiction, younger age, low alcohol intake and no cannabis use in univariate analyses. Short duration of opioid dependence syndrome (3 years) and low alcohol intake (<10 units/week) were significant independent predictors for longer-term retention in treatment in subsequent multivariate analysis.

Clinical implications

Low alcohol intake and shorter duration of addiction were significant independent predictors for longer-term retention in treatment, but retention rates for naltrexone remain low overall. Additional psychosocial support may be needed to address these issues.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Zubair A. Chaudhry (zubair.chaudhry@nhs.net)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 National Institute for Health and Clinical Excellence. Naltrexone for the Management of Opioid Dependence. NICE Technology Appraisal Guidance 115. NICE, 2007.
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BJPsych Bulletin
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  • EISSN: 1758-3217
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Predictors for retention in treatment with a UK community-based naltrexone programme for opioid dependence

  • Zubair A. Chaudhry (a1), Javaid Sultan (a2) and Farrukh Alam (a1)
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eLetters

Are the results only limited by ethnicity?

Chaitra Suresh, Senior Registrar , ST6 in Addictions Psychiatry
06 July 2012

We found the article by Zubair A Choudhry et al (1) a very interesting read. Although retrospective, given good sample size and appropriate period of follow up, the results are informative and useful. We applaud the effort to identify the subgroup of opiate free patients whocould benefit the most from naltrexone for relapse prevention.

It is striking that the study population had Asian men in such a highproportion which certainly makes the sample atypical. The authors have mentioned about associated factors predicting favourable outcome for this group. Could we request the authors to comment on possible difference in metabolism of naltrexone which might influence outcome? There is now evidence to support the fact that pharmacogenetic characteristics of Asianpopulation is associated with improved biobehavioral and clinical responseto naltrexone(2).

The results might have further been affected by personality characteristics within the study group. This would have been valuable information.

We also wondered why the Naltrexone challenge was only done for 80.3%of the study population and information about how many failed the challenge would be useful as selecting only the ones who passed the challenge again selects the highly motivated group which may not be representative. It might be useful to share with us the facts around the same.Finally, we wondered if the authors might want to comment on the wider context given that the results have shown again that the retention rates in naltrexone treatment are not very high. It is worth noting that even ifretained in treatment, efficacy of oral naltrexone in relapse prevention for opioid use is not significant (3) compared to placebo.

References:

1.Predictors for retention in treatment with a UK community-based naltrexone programme for opioid dependence, Zubair A. Chaudhry, Javaid Sultan and Farrukh Alam, The Psychiatrist (2012) 36: 218-2242.Ray L A, Bujarski S, Chin P F, Miotto K. Pharmacogenetics of Naltrexone in Asian Americans: A Randomized Placebo-Controlled Laboratory Study. Neuropsychopharmacology .2012 Jan;37(2):445-553.Minozzi S, Amato L, Vecchi S, Davoli M, Kirchmayer U, Verster A. Oral naltrexone maintenance treatment for opioid dependence. The Cochrane Library 2008.

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Conflict of interest: All authors work in Substance misuse service, Tees Esk and Wear Valley NHS Trust

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