Level of Evidence = D


Evidence is insufficient for conclusions about the effectiveness of naltrexone maintenance treatment in opioid dependence.

Thirteen studies with 1 158 participants were included in a Cochrane review [1]. Comparing naltrexone versus placebo or no pharmacological treatments, no statistically significant difference were noted for all the primary outcomes considered. The only outcome statistically significant in favour of naltrexone is re incarceration (RR 0.47, 95% CI 0.26 to 0.84; 2 studies, n= 86). Considering only studies were patients were forced to adherence a statistical significant difference in favour of naltrexone was found for retention and abstinence (RR 2.93, 95% CI 1.66 to 5.18). Comparing naltrexone versus psychotherapy, in the two considered outcomes, no statistically significant difference was found in the single study considered. Naltrexone was not superior to benzodiazepines and to buprenorphine for retention and abstinence and side effects. Results come from single studies. Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment), imprecise results (limited study size for each comparison) and by inconsistency (variability in results across studies and heterogeneity in interventions and outcomes).

References

1. Minozzi S, Amato L, Vecchi S, Davoli M, Kirchmayer U, Verster A. Oral naltrexone maintenance treatment for opioid dependence. Cochrane Database Syst Rev 2011;(4):CD001333.  [PMID:21491383].

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