Benzodiazepine use and misuse exceed previously cited numbers

Abstract

Injectable naltrexone does not increase comorbid symptoms in opioid addiction Extended-release naltrexone has received increased attention as a viable treatment alternative for opioid dependence, but there has been little research on how this opioid antagonist treatment compares to agonist drugs in terms of its effects on anxiety, depression, and insomnia. A randomized trial of 159 participants compared shortand long-term effects of extended-release naltrexone and the buprenorphine-naloxone combination on these symptoms. Men and women ages 18 to 60 with opioid dependence were eligible for the study. Other drug or alcohol dependence was among the exclusion criteria. The study consisted of two stages: a 12-week randomized trial in which patients received either a naltrexone injection every 4 weeks or daily and individually dosed buprenorphine-naloxone, and a 36-week open-label follow-up in which participants chose one of the two treatments. Change in anxiety and depression symptoms was measured with the Hopkins Symptom Checklist, and insomnia was evaluated using the Insomnia Severity Index. Two-thirds of the participants completed the randomized phase of the study, with 117 of the 122 preferring extendedrelease naltrexone in the open-label phase. No between-group differences were found in the randomized phase on anxiety and depression measures, but insomnia scores were significantly lower in the extendedrelease naltrexone group. In the open-label phase, there were no overall differences on any of the measures between participants who had remained on extended-release naltrexone and those who had switched to naltrexone from buprenorphine-naloxone. The researchers concluded that there appears to be no basis to avoid extendedrelease naltrexone in patients exhibiting symptoms of anxiety, depression, or insomnia. [Latif Z, et al. JAMA Psychiatry 2018; published online Dec 19; doi: 10.1001/jamapsychiatry.2018.3537]