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Heroin Addiction and Related Clinical Problems: 2004, 06, 1 (pages: 43 - 52)

Naltrexone as maintenance therapy for heroin addiction: Predictors of response

Maremmani I., Pacini M., Giuntoli G., Lovrecic M., Perugi G.

Summary: Naltrexone has been shown to have poor results on unselected populations of heroin addicts. Its use is mostly confined to detoxification-related procedures, whereas its long-term effects and properties have been largely neglected. The present study investigates the predictors of successful outcome in a population of 149 current heroin abusers selected as being opioid non-tolerant by a baseline naloxone test, and diagnosed as heroin addicts on the basis of DSM-IV criteria and undergoing long-term naltrexone treatment (naltrexone maintenance). Positive outcome is related to ongoing treatment, whereas negative outcome is due to treatment discontinuation through addictive relapse. Retained individuals are more likely to have no problems at work and to be psychosocially adjusted. Earlier substance users are those most likely to drop out. Global psychopathological impairment, with special reference to mood, aggressiveness and delusions are negatively related to treatment retention. Naltrexone maintenance appears to be suitable for a subgroup of heroin abusers whose clinical pictures combine a low level of addictive disease with the absence of major dysphoria, aggressive behaviour and psychosis.