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Constipation is a very common and one of the most persistent side effects of opioids. In many cases constipation causes severe discomfort and puts limitations on methadone maintenance treatment (MMT). Conventional laxatives are not always effective and do not address the pathophysiological basis of constipation. It was suggested that opioid receptor antagonists with low oral bioavailability e.g. naloxone might reverse constipation while not affecting the course of MMT.
The aim of the study is to assess the feasibility and effectiveness of oral naloxone for methadone-induced constipation in MMT patients.
1. To assess the changes in bowel functioning in constipated patients receiving oral naloxone
2. To describe the opioid withdrawal symptoms due to oral naloxone administration
3. To evaluate the changes in quality of life in patients receiving oral naloxone
Randomized placebo-controlled trial (n=20).
Five patients were enrolled into the study. All of them completed the 16-day study protocol. Mild opioid withdrawal symptoms (perspiration) that lasted for several hours were observed once in 3 out of 5 patients and did not affect the MMT. Constipation reversal was achieved in 4 out of 5 patients as well as significant reduction of laxative use. Over the course of the study substantial improvement in quality of life was observed in those patients whose constipation was relieved.
The preliminary results indicate that oral naloxone is a feasible treatment for constipation in MMT patients. Definite conclusions and evaluation of placebo effects will be possible after completion of the study and unblinding.
Both major depressive disorder (MDD) and alcohol use disorder are highly prevalent, often comorbid and cause significant socioeconomic burden. At CAMH, we have developed and integrated care pathway (ICP) to treat these disorders and evaluated its effectiveness in comparison to treatment as usual (TAU)
Chart review; descriptive statistics, c2 and t-tests, linear mixed effects models, Kaplan–Meier and log-rank analyses.
Overall, 81 patients were enrolled into ICP. Comparisons of treatment retention rates between ICP patients and matched historical controls (n = 81) showed significantly lower dropout rate in ICP cohort (18.5% vs. 69.1%, P < 0.001, Fig. 1). The ICP patients demonstrated significant reduction in depressive symptoms severity (QIDS: 14.6 vs. 10.0, P < 0.001; BDI 26.3 vs. 16.2, P < 0.001), reduction in the amount of alcohol consumed weekly from 44.6 standard drinks at baseline to 12.6 (P < 0.001) by the end of treatment, which was significantly better compared to controls (56.9 vs. 25.2, P < 0.001), P = 0.014 (Fig. 2).
The ICP is a feasible approach to treatment of concurrent AUD and MDD with significantly higher retention rates than TAU. Patients demonstrate improvements on several levels including depressive symptoms, and changes in alcohol drinking patterns.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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