Naltrexone with or without fluoxetine for preventing relapse to heroin addiction in St. Petersburg, Russia |
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Authors: | Krupitsky Evgeny M Zvartau Edwin E Masalov Dimitry V Tsoy Marina V Burakov Andrey M Egorova Valentina Y Didenko Tatyana Y Romanova Tatyana N Ivanova Eva B Bespalov Anton Y Verbitskaya Elena V Neznanov Nikolai G Grinenko Alexandr Y O'Brien Charles P Woody George E |
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Affiliation: | aSt. Petersburg Scientific-Research Center of Addictions and Psychopharmacology (affiliated with St. Petersburg State Pavlov Medical University and Bekhterev Research Psychoneurological Institute), St. Petersburg, Russia bDepartment of Psychiatry and Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, PA, USA |
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Abstract: | This randomized placebo-controlled trial tested the efficacy of oral naltrexone with or without fluoxetine for preventing relapse to heroin addiction and for reducing HIV risk, psychiatric symptoms, and outcome. All patients received drug counseling with parental or significant-other involvement to encourage adherence. Patients totaling 414 were approached, 343 gave informed consent, and 280 were randomized (mean age, 23.6 ± 0.4 years). At 6 months, two to three times as many naltrexone patients as naltrexone placebo patients remained in treatment and had not relapsed, odds ratio (OR) = 3.5 (1.96–6.12), p < .0001. Overall, adding fluoxetine did not improve outcomes, OR = 1.35 (0.68–2.66), p = .49; however, women receiving naltrexone and fluoxetine showed a trend toward a statistically significant advantage when compared to women receiving naltrexone and fluoxetine placebo, OR = 2.4 (0.88–6.59), p = .08. HIV risk, psychiatric symptoms, and overall adjustment were markedly improved among all patients who remained on treatment and did not relapse, regardless of group assignment. More widespread use of naltrexone could be an important addition to addiction treatment and HIV prevention in Russia. |
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Keywords: | Naltrexone Heroin addiction HIV |
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