A systematic review and meta-analysis of naltrexone implants for the treatment of opioid dependence

Larney, Sarah, Gowing, Linda, Mattick, Richard P., Farrell, Michael, Hall, Wayne and Degenhardt, Louisa (2013) A systematic review and meta-analysis of naltrexone implants for the treatment of opioid dependence. Drug and Alcohol Review, 33 2: 115-128. doi:10.1111/dar.12095


Author Larney, Sarah
Gowing, Linda
Mattick, Richard P.
Farrell, Michael
Hall, Wayne
Degenhardt, Louisa
Title A systematic review and meta-analysis of naltrexone implants for the treatment of opioid dependence
Journal name Drug and Alcohol Review   Check publisher's open access policy
ISSN 0959-5236
1465-3362
Publication date 2013-01-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1111/dar.12095
Volume 33
Issue 2
Start page 115
End page 128
Total pages 14
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell
Collection year 2014
Language eng
Formatted abstract
Introduction and Aims: Naltrexone implants are used to treat opioid dependence, but their safety and efficacy remain poorly understood. We systematically reviewed the literature to assess the safety and efficacy of naltrexone implants for treating opioid dependence.

Design and Methods: Studies were eligible if they compared naltrexone implants with another intervention or placebo. Examined outcomes were induction to treatment, retention in treatment, opioid and non-opioid use, adverse events, non-fatal overdose and mortality. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Data from randomised studies were combined using meta-analysis. Data from non-randomised studies were presented narratively.

Results: Five randomised trials (n=576) and four non-randomised studies (n=8358) were eligible for review. The quality of the evidence ranged from moderate to very low. Naltrexone implants were superior to placebo implants [risk ratio (RR): 0.57; 95% confidence interval (CI) 0.48, 0.68; k=2] and oral naltrexone (RR: 0.57; 95% CI 0.47, 0.70; k=2) in suppressing opioid use. No difference in opioid use was observed between naltrexone implants and methadone maintenance (standardised mean difference: -0.33; 95% CI -0.93, 0.26; k=1); however, this finding was based on low-quality evidence from one study.

Discussion: The evidence on safety and efficacy of naltrexone implants is limited in quantity and quality, and the evidence has little clinical utility in settings where effective treatments for opioid dependence are used.

Conclusion: Better designed research is needed to establish the safety and efficacy of naltrexone implants. Until such time, their use should be limited to clinical trials.
Keyword Heroin
Investigational therapies
Naltrexone
Opioid dependence
Systematic review
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: UQ Centre for Clinical Research Publications
Official 2014 Collection
 
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Created: Fri, 28 Feb 2014, 00:11:13 EST by Roheen Gill on behalf of UQ Centre for Clinical Research