Archive for category Naltrexone'

The Theoretical Basis of Narcotic Addiction Treatment with Narcotic Antagonists

The theoretical basis of narcotic addiction treatment with narcotic antagonists was well stated by Martin et al. (). Briefly, outpatient maintenance of a previously detoxified opioid addict on a daily oral opioid-blocking dose of a narcotic antagonist is expected to accomplish two objectives: (a) to remove the incentive for seeking and using opioid drugs; and (b), to extinguish conditioned abstinence (including “craving”) should this phenomenon occur as a response to environmental stimuli to which unconditioned abstinence had previously become conditioned (). Needless to add, such a period of out-patient maintenance on a narcotic antagonist should be used to “rehabilitate” the patient – i.e., to train him in the skills necessary for holding a socially useful job. to form new, mutually supportive relationships with non-drug using persons, and to persuade him to give up the illegal “hustling” activities which had become self-reinforcing during previous periods of opioid addiction. Such a period of out-patient maintenance on a narcotic antagonist would have advantages over detoxification followed by enforced abstention from opioids (by prison sentences with or without a subsequent probationary period) in Read more […]

A Point of View Concerning Treatment Approaches with Narcotic Antagonists

When narcotic antagonists were first introduced into the treatment of drug addiction, patients were placed on the medication without regard to selection criteria and assessments of “successes” or “failures” were made only on the basis of their retention in the program. Since that time, however, our evaluation criteria have become more refined and we have begun to look at more complex questions such as: Are these compounds “helpful” and if so, “for whom” and by what treatment techniques can we augment their usefulness? A salient aspect of our naltrexone studies, for example, is addressed to the question of “for whom?” Hopefully when our data analysis is completed, it will contribute to either affirming or negating the conceptual model that we have formulated to aid us in the differential diagnosis and treatment of opiate dependent individuals. For my presentation today I have chosen to share with you some aspects of our point of view concerning treatment approaches based on our clinical experience. As investigators, we are all committed to the rigors of science with its demand for carefully controlled data. However, I am not addressing myself to specific research data, but rather to some issues concerning the application Read more […]

The development of sustained action preparations of narcotic antagonists

The use of narcotic antagonists in the treatment of opiate addiction is based on the concept of a pharmaceutical agent capable of blocking the reinforcing properties of a dose of opiate taken during an addicts rehabilitation. The rationale for use is that the antagonist blocks the opiate “high” and makes it pleasureless, thus removing the addict’s incentive for continued use. Earlier successful therapy with cyclazocine and naloxone prompted the full-scale development of new and superior antagonists. Presently naltrexone is the drug under the most intensive clinical evaluation and appears to be a promising antagonist candidate. It was felt from the outset that a most desirable component of antagonist therapy would be long-acting drug, so that the need for an addict to decide to take his medication would be minimized. Naltrexone in oral doses of 70 mg. will provide adequate blocking protection for at least 48 hours, or perhaps 72 hours in certain individuals. This is not felt to be a long enough interval between dosages to aid the addict in becoming dissociated from his drug-taking behavior. It was recognized very early that in order to achieve the desired one week, one month or longer duration between dosages, Read more […]

Nida’s Naltrexone Research Program

The current naltrexone research program sup ported by the National Institute on Drug Abuse can be traced developmentally to its embryonic beginnings in the mid-1960’s. At that time Dr. William Martin and his co-workers at the Addiction Research Center in Lexington, Kentucky initiated a series of studies into the use of narcotic antagonists for the treatment of opioid dependence (). The studies were a practical outgrowth of the theoretical formulations elaborated by Dr. Abraham Wikler over the preceding years (). The results of the studies showed that a narcotic antagonist could be effectively used to block the euphorigenic and dependence-producing properties of opioids in man. Furthermore, this chemotherapeutic agent would produce neither physical dependence nor abuse liability in the treated individual. This was important because previous treatment drugs had the liability of producing their own degree of addiction. These early clinical studies into the therapeutic use of narcotic antagonists might have faded into textbook obscurity had it not been for a number of concurrent social and political events that were rapidly developing. In the years following the tragedy of President Kennedy’s assassination on November Read more […]

Naltrexone in the Treatment of Opiate Dependence

At the Division of Drug Abuse Research and Treatment of New York Medical College, we began using naltrexone early in 1973, and studies are continuing at the present time. Over the past four years, more than 400 opiate addicts have been detoxified and inducted onto naltrexone by members of our staff. Our clinic is located in the East Harlem section of New York City, where the incidence of opiate addiction is exceptionally high. The clinic’s patient population is comprised of individuals from all levels of society, although most are of low socioeconomic status and have a high incidence of unemployment and use of public assistance. On the average, 38 percent are black, 38 percent are Puerto Rican, and 24 percent are white. Heroin and/or illicit methadone are the drugs primarily abused. Patients are referred to us by community service agencies, by nearby ambulatory detoxification facilities, and by expatients or those continuing in treatment. The clinic’s staff includes psychiatrists, internists, psychologists, nurses, social workers, vocational and recreational therapists, students in the mental health professions, and paraprofessional counselors. This report summarizes the results of four years’ clinical experience Read more […]

Naltrexone in the Treatment of Opiate Dependence: Clinical Efficacy

Predictive Variables Our evaluation of naltrexone’s clinical efficacy focused primarily upon identifying opiate users most likely to benefit from naltrexone treatment (). This focus emerged from earlier work with cyclazocine () which presented a typological classification of opiate users based upon patients’ self-ratings of the role opiates play in their lives. Briefly, two major groups were identified and shown to have a differential response to cyclazocine treatment. One group appeared to use opiates as a form of “self-medication” to relieve chronic emotional symptoms or stress. They indicated that the drug reduced their inhibitions, anxieties, and painful affects, and perceived themselves to function better with opiates in their system as compared with periods when they were opiate-free. In general, such individuals discontinued cyclazocine treatment prematurely. By contrast, the other group seemed to use heroin as a result of environmental influences: in these individuals disorders of feeling and impaired capacity to function without opiates did not predominate. In general, such individuals remained in cyclazocine treatment for longer periods of time. Based upon these earlier findings with cyclazocine Read more […]

Update on Naltrexone Treatment

Our group in Philadelphia has used naltrexone in the treatment of 201 narcotic addicts in 258 separate treatment episodes as of 1 July 1977. The antagonist treatment program is an important part of our overall multimodality program which includes methadone or propoxyphene maintenance treatment, inpatient detoxification, long-term therapeutic community, family, group, and individual therapies, and a variety of behavioral treatments. Narcotic antagonist treatment, of course, appeals only to those patients who are genuinely interested in becoming drug free. It is not nearly as popular as methadone treatment, but it occupies an important niche — amounting to 5-10 percent of our total patient population at some time in their treatment careers. Our narcotic antagonist patients are demographically similar to our other patients: mean age 27, 60 percent black, more than 95 percent male, and more than 95 percent veterans of military service. Our methods for detoxification from narcotics and institution of antagonist therapy have been reported elsewhere (2, 4); they are similar to those described by others. We use intravenous naloxone prior to the first naltrexone dose to detect residual physical dependence and thus reduce Read more […]

Historical Trends in Naltrexone Research

The development of the narcotic antagonist, naltrexone, has related to and reflected in a fascinating way various medical and psychiatric research trends as well as an array of social and political trends. It has involved innovative cooperation between the clinical community, multiple research groups, various Federal Government agencies, and private industry. Through this cooperative interest in the project, and of course due to the pressing social need to devise new treatment approaches to the problem of heroin abuse, the research effort has yielded what seems to be a most promising and safe chemotherapeutic addition to opiate dependence therapy. The existence of narcotic antagonist agents has been known since the early twentieth century. Initially, the primary interest in this class of drugs focused on their ability to counteract the effects of opiates in man and on their consequent use in the treatment of acute opiate overdose. This application, of course, was of direct medical life-saving use in hospital emergency rooms across the country. The main agent used for this purpose has become naloxone, which is a potent narcotic antagonist with a short duration of action. However, concurrent laboratory research within Read more […]

Naltrexone: The Clinical Investigator’s Dilemma

In the summer of 1974 we became involved in a clinical investigation using the narcotic antagonist naltrexone in the treatment of heroin addicts. The study was organized by the Committee on Clinical Evaluation of Narcotic Antagonists (CENA), U.S. National Academy of Sciences National Research Council (NAS/NRC), under contract to the U.S. National Institute on Drug Abuse (NIDA), U.S. Department of Health, Education, and Welfare. Naltrexone was chosen because of its high efficacy after oral administration, its virtual lack of agonistic properties, and its relatively long duration of action. The goals of the study were to examine the acceptability of naltrexone at the clinical level and to provide some preliminary assessment of its toxicity and efficacy in this context. Under three separate double blind protocols, three distinct populations of addicts were studied: (1) “street addicts” (patients currently addicted who either could not or would not enter methadone maintenance programs), (2) “postaddicts” (former addicts, typically recently released from incarceration and more or less under external pressure to remain in treatment), and (3) methadone maintenance patients who wished to detoxify and become drug Read more […]