Abstract
Aims and methodTo 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.ResultsAlthough 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 implicationsLow 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.
Highlights
The National Institute for Health and Clinical Excellence (NICE) has reported that naltrexone is recommended as a treatment option in detoxified formerly opioid-dependent people who are highly motivated to remain on an abstinence programme
Patients attending the clinic were assessed for suitability for naltrexone treatment
The analysis was conducted on 142 of 220 people dependent on opioids who were initiated on naltrexone treatment at the treatment centre during the study period
Summary
220 patients successfully achieved opioid detoxification and were prescribed naltrexone at the community drug treatment centre. The results, summarised, indicate that when examined separately, eight different sociodemographic and addiction-related parameters had a statistically significant effect influencing long-term naltrexone treatment (stage III use). Multivariate analysis The multivariate analysis indicated that only alcohol and addiction duration were statistically significant independent predictors for continuation to stage III (Table 4). After adjusting for these two factors, there was no evidence of an effect of ethnicity, employment, boredom, cannabis, supervision or age on continuing to stage III. The odds of retention in treatment to stage III were over three times smaller in patients who drank [10-40] units of alcohol per week compared with those who drank no alcohol. The odds of patients with addiction duration of 7 or more years continuing to stage III were a seventh of the odds of patients addicted for 3 years or less continuing to stage III
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