Trial reportDrug and alcohol dependence2013
Naltrexone treatment for opioid dependence: does its effectiveness depend on testing the blockade?
Trial report in Drug and alcohol dependence, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 42 citations in OpenAlex.
- The effects of naltrexone on retention in treatment and being opioid-free in opioid-dependent people: A systematic review and meta-analysis.Frontiers in psychiatry · 2022Pooled it
- Diversity inclusion in United States opioid pharmacological treatment trials: A systematic review.Experimental and clinical psychopharmacology · 2021Pooled it
- Opioid use and dropout from extended-release naltrexone in a controlled trial: implications for mechanism.Addiction (Abingdon, England) · 2020Trial
- A Randomized Trial Comparing Extended-Release Injectable Suspension and Oral Naltrexone, Both Combined With Behavioral Therapy, for the Treatment of Opioid Use Disorder.The American journal of psychiatry · 2019Trial
- Effects of extended-release naltrexone on the brain response to drug-related stimuli in patients with opioid use disorder.Journal of psychiatry & neuroscience : JPN · 2018Trial
- Opioid use and dropout in patients receiving oral naltrexone with or without single administration of injection naltrexone.Drug and alcohol dependence · 2015Trial
- A placebo-controlled trial of memantine as an adjunct to injectable extended-release naltrexone for opioid dependence.Journal of substance abuse treatmentTrial
- Open-label Study of Injectable Extended-release Naltrexone (XR-NTX) in Healthcare Professionals With Opioid Dependence.Journal of addiction medicineTrial
- Impaired olfactory function in substance use disorder.Psychopharmacology · 2025Article
- IMPAIRED OLFACTORY FUNCTION IN SUBSTANCE USE DISORDER.medRxiv : the preprint server for health sciences · 2025Article
- A humanized monoclonal antibody attenuates fentanyl self-administration and reverses and prevents fentanyl-induced ventilatory depression in rhesus monkeys.Psychopharmacology · 2025Article
- Medial prefrontal neuroplasticity during extended-release naltrexone treatment of opioid use disorder - a longitudinal structural magnetic resonance imaging study.Translational psychiatry · 2024Article
- The potential role of opioid vaccines and monoclonal antibodies in the opioid overdose crisis.Expert opinion on investigational drugs · 2023Article
- Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies.The American journal on addictions · 2018Review
- Factors associated with using opiates while under extended-release naltrexone blockade: A descriptive pilot study.Journal of substance abuse treatment · 2018Article
- Sustained opioid antagonism modulates striatal sensitivity to baby schema in opioid use disorder.Journal of substance abuse treatment · 2018Article
- Effects of incentives for naltrexone adherence on opiate abstinence in heroin-dependent adults.Addiction (Abingdon, England) · 2017Article
- Nalmefene is effective at reducing alcohol seeking, treating alcohol-cocaine interactions and reducing alcohol-induced histone deacetylases gene expression in blood.British journal of pharmacology · 2016Article
- Neurobiologic Advances from the Brain Disease Model of Addiction.The New England journal of medicine · 2016Review
- Prescription Opioid Misuse, Abuse, and Treatment in the United States: An Update.The American journal of psychiatry · 2016Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundFDA approval of long-acting injectable naltrexone (Vivitrol) for opioid dependence highlights the relevance of understanding mechanisms of antagonist treatment. Principles of learning suggest an antagonist works through extinguishing drug-seeking behavior, as episodes of drug use ("testing the blockade") fail to produce reinforcement. We hypothesized that opiate use would moderate the effect of naltrexone, specifically, that opiate-positive urines precede dropout in the placebo group, but not in the active-medication groups.
methodsAn 8-week, double-blind, placebo-controlled trial (N=57), compared the efficacy of low (192 mg) and high (384 mg) doses of a long-acting injectable naltrexone (Depotrex) with placebo (Comer et al., 2006). A Cox proportional hazard model was fit, modeling time-to-dropout as a function of treatment assignment and urine toxicology during treatment.
resultsInteraction of opiate urines with treatment group was significant. Opiate-positive urines predicted dropout on placebo and low-dose, but less so on high-dose naltrexone, where positive urines were more likely followed by sustained abstinence. Among patients with no opiate-positive urines, retention was higher in both low- and high-dose naltrexone conditions, compared to placebo.
conclusionsFindings confirm that injection naltrexone produces extinction of drug-seeking behavior after episodes of opiate use. Adequate dosage appears important, as low-dose naltrexone resembled the placebo group; opiate positive urines were likely to be followed by dropout from treatment. The observation of high treatment retention among naltrexone-treated patients who do not test the blockade, suggests naltrexone may also exert direct effects on opiate-taking behavior that do not depend on extinction, perhaps by attenuating craving or normalizing dysregulated hedonic or neuroendocrine systems.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.