Compared with buprenorphine-naloxone, use of extended-release naltrexone maintained abstinence from heroin and other illicit substances at a similar rate, according to the results of research published in JAMA Psychiatry.
In this open-label 12-week trial, researchers randomly assigned outpatients from addiction clinics to receive intramuscular extended-release naltrexone, 380 mg every 4 weeks (n=80) or buprenorphine-naloxone, 4 to 24 mg/d n=79). Researchers evaluated the completion rates, the proportion of opioid-negative drug test results, and the number of days participants used heroin or other illicit opioids.
A total of 66% of patients completed the trial, with a noninferior rate of completion in the extended-release naltrexone group compared with the buprenorphine-naloxone group (P =.04). The mean (SD) length of trial participation was 69.3 (25.9) days for extended-release naltrexone and 63.7 (29.9) days for buprenorphine-naloxone.
Extended-release naltrexone use resulted in a noninferior proportion of total number of opioid-negative drug test results (mean [SD] 0.9 [0.3]) compared with buprenorphine-naloxone (0.8 [0.4]; P <.001). Similarly, use of heroin and other illicit opioids was noninferior in the extended-release naltrexone group (P <.001 for both).
In a superiority analysis, use of extended-release naltrexone was associated with significantly lower rates of heroin and other illicit opioid use. Most other illicit substances used were not significantly different between the two groups.
The study authors concluded that “maintaining short-term abstinence from illicit opioids and other substances with extended-release naltrexone was as effective and safe as [with] buprenorphine-naloxone. Extended-release naltrexone should be an available treatment option for opioid-dependent individuals.”
Tanum L, Solli KK, Latif ZE, et al. The effectiveness of injectable extended-release naltrexone vs daily buprenorphine-naloxone for opioid dependence: a randomized clinical noninferiority trial [published online October 18, 2017]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.3206