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Comment & Response
March 2014

Prescription Opioid Dependence: The Clinical Challenge

Author Affiliations
  • 1Beth Israel Medical Center, New York, New York
JAMA Psychiatry. 2014;71(3):338. doi:10.1001/jamapsychiatry.2013.4530

To the Editor In an article in JAMA Psychiatry, Sigmon and colleagues1 concluded that their findings “suggest that a meaningful subset of [prescription opioid]–dependent outpatients may respond positively to a 4-week taper plus naltrexone maintenance intervention.” It would seem this is an overly positive assessment.

First, the number of participants was very small; the best outcomes were achieved with just 22 individuals assigned to the 4-week taper group. Furthermore, the best was not particularly good since half of these individuals had relapsed to nonprescribed opioid use 4 weeks after detoxification was completed and before naltrexone maintenance could be initiated. Because opioid dependence is recognized as a chronic condition, the outcome beyond the 8 weeks of this trial would presumably be very substantially worse.

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