Naltrexone With or Without Guanfacine for Preventing Relapse to Opiate Addiction in St.-Petersburg, Russia.

Naltrexone with or without guanfacine for preventing relapse to opiate addiction in St.-Petersburg, Russia.

Drug Alcohol Depend. 2013 May 15;
Krupitsky E, Zvartau E, Blokhina E, Verbitskaya E, Tsoy M, Wahlgren V, Burakov A, Masalov D, Romanova TN, Palatkin V, Tyurina A, Yaroslavtseva T, Sinha R, Kosten TR

BACKGROUND: Stress is a key precipitant to discontinuing naltrexone and relapsing to opiate abuse. Alpha-2 adrenergic agonists like guanfacine may reduce stress induced craving and have reduced opiate relapse in small clinical trials. METHODS: This randomized, double blind double dummy placebo-controlled 6-month trial tested oral naltrexone with or without guanfacine for reducing stress and preventing opiate relapse. We randomized 301 patients to: naltrexone 50mg/day+guanfacine 1mg/day (n=75) (N/G), naltrexone+guanfacine placebo (N/P) (n=76), naltrexone placebo+guanfacine (n=75) (P/G), and double placebo (n=75) (P/P). RESULTS: Among the 75 patients in each group the percentage still retained on naltrexone treatment at six months was: N/G 26.7%, N/P 19.7% (p=0.258 to N/G), P/G 6.7% (p<0.05 to both N groups), and P/P 10.7% (p=0.013 to N+G). Guanfacine reduced the severity of stress particularly at weeks 10 and 18. Adverse events (AE) were infrequent (4.7%) without group differences, with most common AEs: headache, poor appetite, insomnia, and dizziness. CONCLUSIONS: Adding guanfacine to naltrexone did not improve treatment retention or opiate free urines, but it reduced both stress and craving at later time points in treatment, which may be related to stress-induced craving and the animal model of incubation of reinstatement. During treatment, HIV risk, anxiety, and depression reduced among all patients in treatment, regardless of group. HubMed – addiction

Sanctions against Iran and the impact on drug use and addiction treatment.

Int J Drug Policy. 2013 May 15;
Shariatirad S, Maarefvand M

There are growing concerns over effects of sanctions against Iran on addiction treatment programmes. Shortages in essential medical supplies, patient’s less access to treatment services due to economic restrictions, financial problems for NGOs and harm reduction programmes and also change in drug markets in Iran and the region are some negative effects of sanctions. The most effective solution to prevent further deterioration in the drug use and drug treatment situation and drug trafficking in Iran and region is ending the sanctions. HubMed – addiction

DRD2/ANKK1 Taq1A polymorphism (rs1800497) has opposing effects on D2/3 receptor binding in healthy controls and patients with major depressive disorder.

Int J Neuropsychopharmacol. 2013 May 20; 1-7
Savitz J, Hodgkinson CA, Martin-Soelch C, Shen PH, Szczepanik J, Nugent AC, Herscovitch P, Grace AA, Goldman D, Drevets WC

The A1 allele of the DRD2/ANKK1 Taq1A polymorphism (rs1800497) is associated with reduced striatal D2/3 receptor binding in healthy individuals (Con) as well as depression and addiction. However, the effect of rs1800497 on D2/3 receptor binding in depressed patients as well as the SNP’s effect on D2/3 binding during reward-associated dopamine release is unknown. Twelve unmedicated patients with major depressive disorder (MDD) and 24 Con completed PET scans with [11C]raclopride, once without receiving monetary rewards (baseline) and once while winning money. In Con, the A1 allele was associated with reduced baseline binding potential (BPND) in the middle caudate and ventral striatum. However, in MDD patients the A1 allele was associated with increased baseline BPND in these regions. There were no significant associations between rs1800497 and change in BPND during reward-associated dopamine release. Conceivably, the A1 allele predisposes to depression and addiction via its effect on the post-synaptic D2 receptor. HubMed – addiction

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