Opiate Antagonists for Alcohol Dependence: Do They Work?

Many studies have examined the role of opiate antagonists in treating alcohol dependence. To summarize the findings of these studies, researchers from the Cochrane Collaboration systematically reviewed all relevant randomized controlled trials (RCTs) of opiate antagonists, including 27 RCTs of naltrexone and 2 RCTs of nalmefene. In most trials, subjects also received psychosocial treatment.

• Most of the identified studies examined short-term (up to 12 weeks) treatment with naltrexone and short-term outcomes. The majority of these studies found that naltrexone, compared with placebo, decreased the risks of returning to heavy drinking (relative risk [RR] 0.6, a significant finding) and returning to any drinking (RR 0.9, a borderline significant finding).
• In the few studies of short-term treatment and medium-term (>12 weeks to 52 weeks) outcomes, naltrexone significantly decreased the risk of returning to heavy drinking (RR 0.8) but not returning to any drinking.
• Studies that directly compared naltrexone with other drugs (e.g., acamprosate, disulfiram) were inconclusive but generally favored naltrexone.
• The few placebo-controlled studies of nalmefene found that short-term treatment with the drug significantly decreased the short-term risk of returning to any drinking (RR 0.6); data on returning to heavy drinking, medium-term treatment, and medium-term outcomes were not reported.

Comments:

High-quality RCTs support the short-term use of naltrexone for treating alcohol dependence. Nalmefene shows promise but is only supported by 2 small studies. Longer-term studies, including comparisons with other biological and behavioral treatments, are needed to determine the appropriate medium- and long-term use of opiate antagonists in treating alcohol dependence.

Kevin L. Kraemer, MD, MSc

Reference:

Srisurapanont M, Jarusuraisin N. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev. 2005;Volume 1.