Date of Award

2012

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective evidence based medicine review is to determine whether or not a naltrexone implant is more effective than oral drug therapy and/or behavioral therapy at reducing heroin use in recovering heroin dependent adults.

STUDY DESIGN: Review of three English language primary studies published from 2007 to 2010.

DATA SOURCE: Three randomized controlled trails comparing naltrexone implants to oral naltrexone, methadone, and usual aftercare found using Ovid, Pub med and Cochrane databases

OUTCOME MEASURED: The primary outcomes measured by all three studies all three articles measured frequency of heroin use by self report

RESULTS: Hulse et al. found that significantly more patients were abstaining from heroin at the 6 month mark with implant naltrexone as compared to oral naltrexone. Kunøe et al. found that implant naltrexone was significantly better than usual aftercare at reducing total number of days of heroin use. Lobmair et al. found naltrexone implants to be similar to methadone treatment at reducing the number of days of heroin use per month.

CONCLUSIONS: Hulse et al. found implantable naltrexone is more effective than oral, and Kunøe et al. found it to be more effective than usual aftercare. Lobamier et al. concludes that methadone is equally effective to the naltrexone implant. These articles suggest that naltrexone implants are as or more effective than other therapies currently being offered. Future studies should be done in order identify individual patient factors that lead to higher efficacy and lower adverse events with implant therapy.

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