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Intermittent marijuana use is associated with improved retention in naltrexone treatment for opiate-dependence.
Am J Addict 2009 Jul-Aug; 18(4):301-8AJ

Abstract

Naltrexone is a theoretically promising alternative to agonist substitution treatment for opioid dependence, but its effectiveness has been severely limited by poor adherence. This study examined, in an independent sample, a previously observed association between moderate cannabis use and improved retention in naltrexone treatment. Opioid dependent patients (N = 63), admitted for inpatient detoxification and induction onto oral naltrexone, and randomized into a six-month trial of intensive behavioral therapy (Behavioral Naltrexone Therapy) versus a control behavioral therapy (Compliance Enhancement), were classified into three levels of cannabis use during treatment based on biweekly urine toxicology: abstinent (0% cannabis positive urine samples); intermittent use (1% to 79% cannabis positive samples); and consistent use (80% or greater cannabis positive samples). Intermittent cannabis users showed superior retention in naltrexone treatment (median days retained = 133; mean = 112.8, SE = 17.5), compared to abstinent (median = 35; mean = 47.3, SE = 9.2) or consistent users (median = 35; mean = 68.3, SE = 14.1) (log rank = 12.2, df = 2, p = .002). The effect remained significant in a Cox model after adjustment for baseline level of heroin use and during treatment level of cocaine use. Intermittent cannabis use was also associated with greater adherence to naltrexone pill-taking. Treatment interacted with cannabis use level, such that intensive behavioral therapy appeared to moderate the adverse prognosis in the consistent cannabis use group. The association between moderate cannabis use and improved retention on naltrexone treatment was replicated. Experimental studies are needed to directly test the hypothesis that cannabinoid agonists exert a beneficial pharmacological effect on naltrexone maintenance and to understand the mechanism.

Authors+Show Affiliations

Division on Substance Abuse, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA. rabywil@pi.cpmc.columbia.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

19444734

Citation

Raby, Wilfrid Noel, et al. "Intermittent Marijuana Use Is Associated With Improved Retention in Naltrexone Treatment for Opiate-dependence." The American Journal On Addictions, vol. 18, no. 4, 2009, pp. 301-8.
Raby WN, Carpenter KM, Rothenberg J, et al. Intermittent marijuana use is associated with improved retention in naltrexone treatment for opiate-dependence. Am J Addict. 2009;18(4):301-8.
Raby, W. N., Carpenter, K. M., Rothenberg, J., Brooks, A. C., Jiang, H., Sullivan, M., ... Nunes, E. V. (2009). Intermittent marijuana use is associated with improved retention in naltrexone treatment for opiate-dependence. The American Journal On Addictions, 18(4), pp. 301-8. doi:10.1080/10550490902927785.
Raby WN, et al. Intermittent Marijuana Use Is Associated With Improved Retention in Naltrexone Treatment for Opiate-dependence. Am J Addict. 2009;18(4):301-8. PubMed PMID: 19444734.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intermittent marijuana use is associated with improved retention in naltrexone treatment for opiate-dependence. AU - Raby,Wilfrid Noel, AU - Carpenter,Kenneth M, AU - Rothenberg,Jami, AU - Brooks,Adam C, AU - Jiang,Huiping, AU - Sullivan,Maria, AU - Bisaga,Adam, AU - Comer,Sandra, AU - Nunes,Edward V, PY - 2009/5/16/entrez PY - 2009/5/16/pubmed PY - 2009/9/22/medline SP - 301 EP - 8 JF - The American journal on addictions JO - Am J Addict VL - 18 IS - 4 N2 - Naltrexone is a theoretically promising alternative to agonist substitution treatment for opioid dependence, but its effectiveness has been severely limited by poor adherence. This study examined, in an independent sample, a previously observed association between moderate cannabis use and improved retention in naltrexone treatment. Opioid dependent patients (N = 63), admitted for inpatient detoxification and induction onto oral naltrexone, and randomized into a six-month trial of intensive behavioral therapy (Behavioral Naltrexone Therapy) versus a control behavioral therapy (Compliance Enhancement), were classified into three levels of cannabis use during treatment based on biweekly urine toxicology: abstinent (0% cannabis positive urine samples); intermittent use (1% to 79% cannabis positive samples); and consistent use (80% or greater cannabis positive samples). Intermittent cannabis users showed superior retention in naltrexone treatment (median days retained = 133; mean = 112.8, SE = 17.5), compared to abstinent (median = 35; mean = 47.3, SE = 9.2) or consistent users (median = 35; mean = 68.3, SE = 14.1) (log rank = 12.2, df = 2, p = .002). The effect remained significant in a Cox model after adjustment for baseline level of heroin use and during treatment level of cocaine use. Intermittent cannabis use was also associated with greater adherence to naltrexone pill-taking. Treatment interacted with cannabis use level, such that intensive behavioral therapy appeared to moderate the adverse prognosis in the consistent cannabis use group. The association between moderate cannabis use and improved retention on naltrexone treatment was replicated. Experimental studies are needed to directly test the hypothesis that cannabinoid agonists exert a beneficial pharmacological effect on naltrexone maintenance and to understand the mechanism. SN - 1521-0391 UR - https://www.unboundmedicine.com/medline/citation/19444734/abstract/Intermittent_marijuana_use_is_associated_with_improved_retention_in_naltrexone_treatment_for_opiate_dependence_ L2 - https://doi.org/10.1080/10550490902927785 DB - PRIME DP - Unbound Medicine ER -