Injectable extended-release naltrexone for opioid dependence.

摘要

Daniel Wolfe and colleagues (April 30, p I468) present a very unbalanced review of published data in an apparent effortto showthat injectable extended-release naltrexone is more dangerous than agonist treatment for a disorder with a known high mortality. For example, they misrepresent the fact that all deaths in the Miotto study occurred after patients stopped oral naltrexone (a problem sustained-release formulations address); ignored missing data in the Digiustostudy that reported excess deaths after naltrexone versus methadone treatment even though 33% of naltrexone patients and 88% of agonist patients had no out-of-treatment observation time; and overlooked that Gibson and Degenhardt compared deaths after naltrexone versus methadone during the first 2 weeks of methadone and did not mention that deaths also increase after patients leave methadone maintenance.