Naltrexone’s current use has been limited by compliance. Subcutaneous implants would seem to offer a solution to this problem and improve long-term outcomes. The aim of the present study was to compare groups of patients who had received oral naltrexone or a naltrexone implant after detoxification and to follow their progress. Forty-one patients received an implant, and 42 patients received oral naltrexone. They were surveyed at one, three, six, and 12 months after detoxification. Their designated support person was also contacted to confirm the self-reports of the participants. Patients were compared on gender, age, and length of time since detoxification. Implant patients showed much higher abstinence rates, while those in both groups who were abstinent showed greater compliance to naltrexone (time spent in treatment) and attended more counseling sessions. Although the participants were not randomly allocated to each treatment condition, the preliminary evidence indicates that implants can improve compliance rates and outcomes.

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ding socio-demographic profile and drug use pattern of the patients was collected followed by urine testing for opioids, naltrexone, and cannabis. Results The primary drug of use among the patients was found to be heroin. The duration of naltrexone use varied from 1 week to 12 months across the study sample and the mean duration of use was found to be 3.4 months. While on naltrexone, substance abuse (excluding opiates) was present in 37.4% patients. Among these patients, 26% were taking alcohol and 11.4% of the patients were consuming cannabis while on medication. The urine sample of all the subjects tested positive for naltrexone indicating good compliance on the medication. Discussion Despite the small sample size and nonhomogeneity in terms of period of being on naltrexone therapy, the study highlights 2 issues. Firstly, naltrexone seems to help patients in staying abstinent from opioid drugs and secondly a significant proportion of patients is likely to indulge in drug substitution like alcohol and/or cannabis. The latter observation raises concerns regarding the efficacy of naltrexone in managing alcohol dependence. The neurochemical basis for the finding needs to be explored in detail and the physician should be cautious about any change of drug use pattern in-patients on treatment with naltrexone....

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Introduction: Neurobiological systems engineering models are useful for treating patients. We show a model of “high opioid tone” autism and present a hypothesis about how autism is caused by administration of opioids during childbirth.Main Symptoms: Clinical diagnosis of autism in a 25 year old man was confirmed by a Social Responsiveness Scale (SRS) self-rating of 79, severe, and a Social Communications Questionnaire (SCQ-2) by the patient's father scoring 27. Cold pressor time (CPT) was 190 seconds—unusually long, consonant with the high pain tolerance of autism.Therapeutic Intervention and Outcomes: At naltrexone 50 mg/day SRS fell to 54 and SCQ-−2–9; both non-significant. CPT fell to 28, repeat 39 s. Improved relatedness was experienced ambivalently, understood as feelings never before experienced—causing pain. Non-compliance with naltrexone was followed by cutting open his palm and drinking alcoholically. Transference focused psychotherapy has helped him remain naltrexone—compliant while he works on issues of identity and relatedness.Conclusion: The model suggests studies that could be conducted to both prevent and treat this form of autism.

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