Naltrexone implants can completely prevent early (1-month) relapse after opiate detoxification: a pilot study of two cohorts totalling 101 patients with a note on naltrexone blood levels
Naltrexone implants can completely prevent early (1-month) relapse after opiate detoxification: a pilot study of two cohorts totalling 101 patients with a note on naltrexone blood levels
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DOI：
10.1080/1355621031000117446
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发表时间：
2003-06-01
影响因子：
3.4
通讯作者：
Steele, T
中科院分区：
文献类型：
--
作者：
Foster, J;Brewer, C;Steele, T
阿片类药物戒断后早期复发很常见，这剥夺了成瘾者发展新的、不含阿片类药物的认知行为习惯的重要机会。口服阿片类拮抗剂纳曲酮（NTX）只有在严格监督和/或与缓刑相关的情况下才能显著减少复发。自1997年以来，简单但有效的NTX植入物，含有1G NTX，平均阻滞时间为6-7周。我们提供了两个队列的结果数据。第一组是首批55名连续植入的英国患者（76%为男性，51%为失业者，64%为社会III-V阶层）。第二组为连续第二组46例。植入物主要在全身麻醉或镇静下快速阿片解毒期间皮下植入。组1随访率为100%。在首次植入后12周，21%的组1患者和26%的组2患者明显恢复了阿片类药物的使用。30%的患者在第一周就通过了阻断试验。在注射后不到5周，没有人报告有任何阿片类药物效应。在其他患者中，注射后4-5周的典型血液NTX水平在3-5 ng/ml范围内，这显然足以阻断500 mg纯diamorphine。NTX植入物对早期复发提供了相当大的保护，并可能增加阿片类药物戒断后治疗有用期的可能性。麻烦的组织反应很少发生。植入技术和持续时间的改进已经在发生。我们强调植入物加强而不是取代治疗联盟。
Early relapse is common after opiate withdrawal and deprives addicts of important opportunities to develop new, opiate-free cognitive-behavioural habits. The oral opiate antagonist naltrexone (NTX) significantly reduces relapse only when rigorously supervised and/or probation-linked. Simple but effective NTX implants, containing 1G NTX and giving an average blockade of 6-7 weeks, have been available since 1997. We present outcome data for two cohorts. Group 1 were the first 55 consecutive implanted British patients (76% male, 51% unemployed, 64% in social classes III-V). Group 2 were a second consecutive group of 46. Implants were inserted subcutaneously mainly during rapid opiate detoxification under general anaesthesia or sedation. The follow-up rate for group 1 was 100%. At 12 weeks after first implantation, 21% of group 1 patients and 26% of group 2 patients had apparently resumed opiate use. Thirty per cent of patients tested-out the blockade in the first week. None reported any opiate effects at less than 5 weeks after insertion. In other patients, typical blood NTX levels 4-5 weeks post-insertion were in the range 3-5 ng/ml, which is evidently enough to block 500 mg of pure diamorphine. NTX implants provide considerable protection against early relapse and may increase the likelihood of therapeutically useful periods of abstinence after opiate withdrawal. Troublesome tissue reactions were infrequent. Improvements in implant technology and duration are already occurring. We stress that implants strengthen rather than replace the therapeutic alliance.