Nav: Home

Opioid treatment drugs have similar outcomes once patients initiate treatment

November 14, 2017

A study comparing the effectiveness of two pharmacologically distinct medications used to treat opioid use disorder - a buprenorphine/naloxone combination and an extended release naltrexone formulation - shows similar outcomes once medication treatment is initiated. Among active opioid users, however, it was more difficult to initiate treatment with the naltrexone. Study participants were dependent on non-prescribed opioids, 82 percent of them on heroin, and 16 percent on pain medications. The research, published today in The Lancet, was conducted at eight sites within the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN). NIDA is part of the National Institutes of Health.

Five hundred and seventy opioid-dependent adults were randomized to the buprenorphine combination or the naltrexone formulation, and followed for up to 24 weeks of outpatient treatment. Study sites differed in their detoxification approaches and in their typical inpatient length of stay. Buprenorphine/naloxone (brand name Suboxone) was given daily as a sublingual film (under the tongue), while naltrexone (brand name Vivitrol) was a monthly intramuscular injection. Adverse events, including overdoses, were tracked.

"Studies show that people with opioid dependence who follow detoxification with no medication are very likely to return to drug use, yet many treatment programs have been slow to accept medications that have proven to be safe and effective," said Nora D. Volkow, M.D., director of NIDA. "These findings should encourage clinicians to use medication protocols, and these important results come at a time when communities are struggling to link a growing number of patients with the most effective individualized treatment."

Scientists conducting the research expected that it would be more difficult to initiate treatment with naltrexone because it requires a full detoxification, and patients often drop out of that process early. However, both the extent of the detoxification "hurdle," and how the medications would compare once they were initiated, was not known.

As expected, fewer patients could successfully initiate naltrexone compared to buprenorphine/naloxone (72.1 percent vs. 94.1 percent). Among all 570 participants, the 24-week relapse rates were slightly higher for naltrexone (65.4 percent) than for buprenorphine/naloxone (56.8 percent), the difference due to early relapse amongst those unable to initiate naltrexone. However, among the 474 participants successfully started on medication, the 24-week relapse rates were similar (52.0 percent for naltrexone vs. 55.6 percent for buprenorphine/naloxone). Other opioid use outcomes - days abstinent, negative urine tests, and time-to-relapse - generally favored buprenorphine/naloxone for the full sample of 570 participants. These same outcomes slightly favored naltrexone for those participants who initiated treatment. During the study, there were five fatal overdoses, three in patients randomized to buprenorphine/naloxone and two to naltrexone. Overall overdose rates, including non-fatal overdoses, were low compared to what would be expected in this population, and strongly support the conclusion that medication protects against overdose.

Researchers note that patients who are unable to complete detoxification and choose naltrexone should be strongly encouraged to initiate the buprenorphine combination treatment, and that improved methods to transition active users to naltrexone need to be developed.

The buprenorphine combination is a partial agonist, while the naltrexone is an antagonist. Their approaches to treating opioid dependence are pharmacologically, conceptually, and logistically different. A partial agonist still binds to opioid receptors, but less strongly, reducing cravings and withdrawal symptoms. It is considered opioid maintenance treatment. An antagonist blocks the activation of opioid receptors, preventing opioids from producing the euphoria. There must be no opioids left in the body before beginning this treatment. So, there are differences in initiating treatment and withdrawal on discontinuation. Until now, these have never been compared head-to-head in the United States, so there have never been the comparative effectiveness data needed to make informed choices.

"The good news is we filled the evidentiary void, and also learned that for those who were able to initiate treatment, the outcomes were essentially identical, as were adverse events," said John Rotrosen, M.D., the study lead investigator. "This gives patients the freedom to choose a treatment approach that best suits their lifestyle, goals and wishes."

Methadone, a third U.S. Food and Drug Administration-approved medication for treating opioid use disorders, was not studied in this project. Methadone is a synthetic opioid agonist usually given in liquid form that has been used successfully for more than 40 years. Methadone must be dispensed through specialized opioid treatment programs, whereas buprenorphine/naloxone and naltrexone can be offered from a doctor's office with a prescription. Methadone has also been prescribed as a treatment for chronic pain.

Overdose deaths linked to opioid pain medicines nearly quadrupled from 2000 to 2014, to nearly 19,000. There is now also a rise in heroin use and heroin addiction as some people report shifting from prescription opioids to heroin because it is cheaper and easier to obtain. In 2015, nearly 600,000 people in the United States had a heroin use disorder and close to 13,000 Americans died of a heroin overdose.
-end-
More information on medications to treat opioid use disorders can be found here: https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/overview

For a commentary by NIDA Director Dr. Nora Volkow, "Medications for opioid use disorder: bridging the gap in care," go to http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32812-X/fulltext?elsca1=tlxpr

About the National Institute on Drug Abuse (NIDA): The National Institute on Drug Abuse (NIDA) is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world's research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. Fact sheets on the health effects of drugs and information on NIDA research and other activities can be found at http://www.drugabuse.gov, which is now compatible with your smartphone, iPad or tablet. To order publications in English or Spanish, call NIDA's DrugPubs research dissemination center at 1-877-NIDA-NIH or 240-645-0228 (TDD) or email requests to drugpubs@nida.nih.gov. Online ordering is available at drugpubs.drugabuse.gov. NIDA's media guide can be found at http://www.drugabuse.gov/publications/media-guide/dear-journalist, and its easy-to-read website can be found at http://www.easyread.drugabuse.gov. You can follow NIDA on Twitter and Facebook.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

NIH/National Institute on Drug Abuse

Related Heroin Articles:

State prescription drug monitoring programs: The rise and fall in heroin fatalities
A new study found a consistent association between the adoption of state Prescription Drug Monitoring programs (PDMP) and death rates from heroin poisoning.
Fingerprint test can distinguish between those who have taken or handled heroin
A state-of-the-art fingerprint detection technology can identify traces of heroin on human skin, even after someone has washed their hands -- and it is also smart enough to tell whether an individual has used the drug or shaken hands with someone who has handled it.
What to call someone who uses heroin?
A first-of-its-kind study by researchers from the Boston University School of Public Health (BUSPH) and the University of Massachusetts Medical School (UMMS), published in the journal Addiction, has found that people entering treatment for heroin use most often called themselves 'addicts,' but preferred that others called them 'people who use drugs.'
Teens abusing painkillers are more likely to later use heroin
A USC study in the July 8, 2019 issue of JAMA Pediatrics shows that teens who use prescription opioids to get high are more likely to start using heroin by high school graduation.
Is nonmedical opioid use by adolescents associated with later risk of heroin use?
This observational study used data from a survey of behavioral health that included students from 10 Los Angeles-area high schools to examine whether nonmedical prescription opioid use was associated with later risk of heroin use in adolescents.
CBD reduces craving and anxiety in people with heroin use disorder
Mount Sinai study highlights the potential of cannabidiol as a treatment option for opioid abuse.
Surgical implications of rising heroin abuse
With heroin abuse on the rise in the United States, related surgical complications are also increasing, including severe infections and complications related to heroin injection.
Heroin users aware of fentanyl, but at high risk of overdosing
Most heroin users in Baltimore, a city heavily affected by the opioid epidemic, recognize that the heroin they buy is now almost always laced with the highly dangerous synthetic opioid fentanyl, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health.
Providing supervised medical-grade heroin to heavy users can reduce harms
Some nations -- but not the US -- provide heroin-assisted treatment and supervised consumption sites as approaches to reduce the harms caused by addiction to opioids.
Dopamine drives early addiction to heroin
Scientists have made a major advance in untangling the brain circuits that lead to the powerful addictive effects of heroin, a study in the open-access journal eLife reports.
More Heroin News and Heroin Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Accessing Better Health
Essential health care is a right, not a privilege ... or is it? This hour, TED speakers explore how we can give everyone access to a healthier way of life, despite who you are or where you live. Guests include physician Raj Panjabi, former NYC health commissioner Mary Bassett, researcher Michael Hendryx, and neuroscientist Rachel Wurzman.
Now Playing: Science for the People

#544 Prosperity Without Growth
The societies we live in are organised around growth, objects, and driving forward a constantly expanding economy as benchmarks of success and prosperity. But this growing consumption at all costs is at odds with our understanding of what our planet can support. How do we lower the environmental impact of economic activity? How do we redefine success and prosperity separate from GDP, which politicians and governments have focused on for decades? We speak with ecological economist Tim Jackson, Professor of Sustainable Development at the University of Surrey, Director of the Centre for the Understanding of Sustainable Propserity, and author of...
Now Playing: Radiolab

An Announcement from Radiolab