The association between naltrexone compliance and daily supervision

Most studies investigating the efficacy of naltrexone maintenance as a trea tment for illicit heroin use have reported poor patient compliance in takin g naltrexone, A number of studies have, howover, reported better compliance when patients receive family therapy, or when patients resided in a suppor tive family environment. These studies suggest that patient outcomes on nal trexone maintenance may: be better if there is ongoing family support to co ntinue naltrexone use. The current study investigated B-month outcome statu s in 300 illicit heroin users who commenced naltrexone maintenance in a com munity-based out-patient treatment programme. The study aimed to assess the relationship between vigilance of naltrexone supervision by salient others over the first 6 weeks of treatment and patient status at 6 months. Superv ision of naltrexone at week 6 was a predictor of a patient's status at 6 mo nths, with those receiving less supervision of 3-4 days more likely to have returned to heroin use or be assessed as 'heroin use undetermined'. In con trast, patients who still received naltrexone supervision for 6 or 7 days p er week at week 6 were more likely to be taking naltrexone or were naltrexo ne- and heroin-free at 6 months. It is argued that since relapse to heroin use is a common occurrence, vigilant supervision of naltrexone dosing in a supportive environment may improve patient retention and reduce relapse. It is suggested that poor outcomes reported in many previous studies may refl ect use of inadequate supportive frameworks that encourage naltrexone compl iance .