Addiction treatment in Russia
A propos your World Report on naltrexone implants and addiction treatment in Russia (July 3, p 13),1 suicide and overdose deaths after detoxification are always a concern, but we know of no evidence that naltrexone treatment increases those risks. In fact, depressive symptoms drop in patients on naltrexone2, 3 and we know of one case in which naltrexone might have prevented a suicide.4
Regarding problems at the implant site, an interim analysis of our current study showed that only four of 66 patients with implants had adverse site reactions and none were serious. Regarding efficacy, patients who continue naltrexone show striking reductions in HIV injecting risk and very little opioid use. Similar positive outcomes were recently reported with Vivitrol – an injectable extended-release naltrexone preparation – at the annual meeting of the American Psychiatric Association.
The return of problems after naltrexone is stopped is no different from what happens after leaving against medical advice, or after stopping methadone, buprenorphine, or any medication used to treat a chronic, relapsing disorder.
Approval of buprenorphine and methadone with training and an infrastructure that allows them to be used safely and effectively would be a great help in Russia, as would financial arrangements to make all three of these medications more widely available. Such arrangements were made for treating HIV. Could the same be done for addiction?
Fidelity Capital provided Prodetoxon at reduced price for the implant study. EV, GEW, and CPOB have been paid consultants to Alkermes. Alkermes has provided Vivitrol for studies led by GEW and CPOB.
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References
1 Holt E. Russian injected drug use soars in face of political inertia. Lancet 2010; 376: 13-14
2 Krupitsky EM, Zvartau EE, Masalov DV, et al. Naltrexone for heroin dependence treatment in Russia. J Subst Abuse Treat 2004; 26: 285-294.
3 Krupitsky EM, Zvartau EE, Masalov DV, et al. Naltrexone and fluoxetine for heroin dependence treatment in St. Petersburg, Russia. J Subst Abuse Treat 2006; 31: 319-328.
4 Krupitsky EM, Masalov DV, Didenko TY, et al. Prevention of suicide by naltrexone in a recently detoxified heroin addict. Eur Addiction 2001; 7: 87-88.
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Evgeny Krupitsky, George E Woody, Edwin Zvartau, Charles P O’Brien