A significant clinical challenge in the treatment of drug dependence is the common abuse of multiple classes of drugs. Targeting one specific class of drugs with a pharmacologic intervention may do little to reduce cravings and use of drugs in other classes.
The number four ranked Brain Post in 2012 suggests naltrexone implants may be effective in reducing use of both opiates and stimulants.
One hundred opiate and stimulant abusers participated in a randomized controlled trial research study. This study used an implantable form of the drug that reduces problems with compliance.
Implantable naltrexone proved superior to placebo implants in study retention (52% vs 28%), proportion of drug free urine samples (38% vs 16%) and clinician rated proportion with good outcomes (56% vs 14%).
This study provides hope for an pharmacologic intervention to be added to standard substance abuse treatment in those with polydrug abuse.
Photo of Christmas ornament angel from the author's files.
The number six ranked post for 2012 on Brain Posts was "Risk Factors for Accidental Overdose". This post examined a research study from the VA that looked a series of accidental overdose deaths in Veterans between 2000 and 2006.
Most of these deaths involved overdose with prescription or illicit drugs. Often a combination of drugs is implicated in an accidental overdose.
Risk factors for accidental deaths as expected included a substance abuse or alcohol abuse diagnosis. Opiate dependence was the strongest risk factor.
However, other psychiatric disorders also increased risk for accidental overdose including: bipolar disorder, major depression, PTSD and schizophrenia. The take home message from this study is that clinicians treating those with mental disorders should monitor patients for risk of death related to prescription and illicit use.
Another post on a related topic demonstrated that risk for accidental overdose with prescription and illicit opiates has more than doubled in the U.S. over the last decade. Rates of opiate-related deaths vary widely between states and are highest in states with the highest rates of opiate prescription use of Lortab, Oxycontin, Vicodin and similar drugs. Public health and law enforcement efforts are underway to reduce the number of accidental opiate overdose deaths.
Photo of Christmas tree angel ornament from the author's files.
