Contingent naloxone treatment of the narcotic addict: a pilot study

In a community-based abstinence program, 108 chronic heroin abusers, paroled from Maryland correctional institutions, were administered the narcotic antagonist, naloxone, in escalating 500 mg dosages to a daily maximum dosage of 2,000 mg when either urine analysis indicated narcotic drug use or unexcused absences led to the suspicion of narcotic intake. Dosage was then continued at the maximum level until the record again indicated abstinence. This approach was regarded as such a distinct departure from customary antagonist administration that a pilot investigation of its effectiveness was undertaken. Six month outcome data on all patients were constrasted with those of an historical comparison group previously treated in the same clinic without naloxone administration. Both groups were equivalent on all criminal history, demographic, and prognostic variables. The group receiving contingent naloxone administration showed a significantly lower institutionalization rate (8%) than that for the reference sample (37%). Complete abstinence rates were also in favor of the naloxone group (38 vs. 12%).

Rapid detoxification of the narcotic addict with naloxone hydrochloride. A preliminary report

Parenteral (0.2--2.0 mg) and oral (500 mg) doses of naloxone hydrochloride were administered to 29 parolees showing evidence of increasing opiate use while participating in an aftercare abstinence program. The naloxone was found to be capable of inducing withdrawal symptoms, the intensity of which being a function of the amount of naloxone administered and of the level of physical dependence. Some patients (38%) showed a "detoxification effect" characterized by a positive abstinence reaction to initial naloxone administrations but a negative reaction to subsequent administrations. All of the 29 subjects, however, returned to illicit heroin use within several days following their release from the treatment unit. the potential of naloxone as a rapid detoxification tool is discussed in counterpoint to the apparent lack of potential the procedure has as a means of attenuating opiate-seeking behavior.

Contingent naloxone (N-allylnoroxymorphone) treatment of the paroled narcotic addict

This is a presentation of the results of pilot and controlled research on the effectiveness of the contingent (upon narcotic drug use) administration of 500-2,000 mg daily, of the narcotic antagonist, naloxone (N-allylnoroxymorphone), to paroled narcotic addicts enrolled in a urine monitoring program conducted in a metropolitan-based outpatient clinic. Criteria of effectiveness, which include clinic attendance, the extent of narcotic drug usage, and final disposition at the end of a 6-month treatment period, are viewed in relation to already established baseline results with a sample of patients processed through the same clinic over a 5-year period prior to the introduction of naloxone treatment. Although results of the pilot study are encouraging, indicating longer patient involvement and less reinstitutionalization than baseline values, the results of the controlled evaluation reveal no benefit from contingently administered naloxone beyond placebo reactivity, which appears to be substantial in the contingent approach. The results are discussed in terms of given sample characteristics, and suggestions are offered regarding the development of new narcotic antagonist treatment approaches.