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Tuesday, June 09, 2020

Comments

1. How can the use of a naltrexone placebo ever be justified with human subjects who are known to use opiates?
2. 24 weeks is a tragically short treatment period. The high drop out rate from opiate use treatment provides little justification for this. My experience has been that many will continue to utilize this as a treatment adjunct for as long as it is available. Methadone programs contemplate lifelong maintenance. Increasingly this is the case with suboxone, as well. Extended release naltrexone should be similarly available. More effort needs to be expended on training counselors to learn how to work with patients for extended time periods. The results of this study demonstrate that longer treatment periods are needed if we are to see lasting results.

Thanks for your comment David. You're right, using placebos in human trials is not always ethical. Here I brought it up as an additional possible study arm because participants in the usual treatment condition were already not receiving any medication for opioid dependence. Also yes, long term continuation of care is certainly a weakness of many addiction treatment options. The success during treatment paired with the lack of difference between groups just a year later sheds light on why future investigation of continuation of care is critically important.

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