Naltrexone to retain people in treatment

In an updated version of a systematic review (Minozzi et al., 2011, 13 RCTs, N=1158), pharmacological treatment with Naltrexone versus placebo or no pharmacological treatment in opioid dependent patients was found:

• to have a statistically significant effect only when considering only the studies with patients forced to adhere to treatment which favoured naltrexone for retention and abstinence.

A new systematic review with network meta-analysis (Lim et al., 2022, 79 RCTs) however found a significant overall effect of Naltrexone compared to control in:

• retaining patients in treatment (RR 1.54, CI 95% 1.26 - 1.90).

The network analysis showed that Buprenorphine and Methadone appear to have superior retention to naltrexone yet based on a small number of studies.

Another systematic review (Timko et al.,2016) covering five years (55 articles, 2010–2014) of research on MAT retention by opiate-dependent individuals suggests that:

• in RCTs with a Medication Focus, the receipt of a naltrexone implant rather than placebo was associated with a higher 3-month retention rate (52.0% vs 28.0%), a higher 6-month retention rates (≥20%), and a longer duration of MAT.
• in RCTs with a Behavioral Therapy Focus compared to naltrexone-only patients, patients receiving naltrexone and contingency management were more likely to be retained at 6 months (16.0% vs 54.0%).