Employment-Based Reinforcement of Adherence to Oral Naltrexone in Unemployed Injection Drug Users: 12-Month Outcomes
Employment-Based Reinforcement of Adherence to Oral Naltrexone in Unemployed Injection Drug Users: 12-Month Outcomes
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DOI：
10.1037/adb0000010
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发表时间：
2015-06-01
影响因子：
3.4
通讯作者：
Silverman, Kenneth
中科院分区：
文献类型：
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作者：
Dunn, Kelly;DeFulio, Anthony;Silverman, Kenneth
对于最近戒毒的阿片类药物依赖患者来说，口服纳曲酮可能是一种有前途的预防复发药物疗法；然而，通常需要采取干预措施来促进对这种治疗方法的依从性。我们最近进行了一项研究，评估对失业注射吸毒者进行的为期 26 周的基于就业的口服纳曲酮强化干预（Dunn 等，2013）。参与者被随机分配到应急组（n = 35），需要在工作人员的观察下摄入纳曲酮才能进入治疗工作场所；或处方组（n = 32），给予带回家的口服纳曲酮并在没有观察到摄入的情况下进入工作场所。每月收集并分析尿液样本，以获取纳曲酮依从性、阿片类药物使用和可卡因使用的证据。正如之前报道的，在 26 周的干预期间，应急参与者提供的纳曲酮阳性尿液样本明显多于处方参与者。本研究的目标是报告干预结束 6 个月后 12 个月的结果。 12 个月访视的结果显示，纳曲酮阳性、阿片类药物阴性或可卡因阴性尿液样本没有组间差异，并且没有参与者在随访时自我报告使用纳曲酮。这些结果表明，即使在成功强化口服纳曲酮依从性一段时间后，在强化意外事件停止后也不太可能维持长期纳曲酮的使用。
Oral naltrexone could be a promising relapse-prevention pharmacotherapy for recently detoxified opioid-dependent patients; however, interventions are often needed to promote adherence with this treatment approach. We recently conducted a study to evaluate a 26-week employment-based reinforcement intervention of oral naltrexone in unemployed injection drug users (Dunn et al., 2013). Participants were randomly assigned into a contingency (n = 35) group required to ingest naltrexone under staff observation to gain entry into a therapeutic workplace or a prescription (n = 32) group given a take-home supply of oral naltrexone and access to the workplace without observed ingestion. Monthly urine samples were collected and analyzed for evidence for naltrexone adherence, opioid use, and cocaine use. As previously reported, contingency participants provided significantly more naltrexone-positive urine samples than prescription participants during the 26-week intervention period. The goal of this current study is to report the 12-month outcomes, which occurred 6 months after the intervention ended. Results at the 12-month visit showed no between-groups differences in naltrexone-positive, opioid-negative, or cocaine-negative urine samples and no participant self-reported using naltrexone at the follow-up visit. These results show that even after a period of successfully reinforced oral naltrexone adherence, longer-term naltrexone use is unlikely to be maintained after reinforcement contingencies are discontinued.