Naltrexone plus benzodiazepine aids abstinence in opioid-dependent patients

Naltrexone (NTX) is widely used to prevent relapse of opioid-dependent patients but its association withinsomnia and bhyperexcitabilityQ can result in treatment withdrawal. We evaluated whether NTX combinedwith the benzodiazepine prazepam was more effective than NTX in keeping patients opioid-free. Wedetermined the relapse rate over 6 months in 56 opioid-dependent subjects, divided into 4 equal groups. Allgroups received psychological support and underwent urine tests for drug metabolites twice weekly. Group 1did not receive pharmacological treatment (controls). Group 2 received NTX alone (one 50-mg tablet daily);group 3 received NTX (one 50-mg tablet daily) plus placebo (one tablet twice daily); and group 4 receivedNTX (one 50-mg tablet daily) plus prazepam (one 10-mg tablet twice daily). Ten patients of group 1 relapsedwithin 3 months, one after 6 months and three remained opioid-free. Six patients of group 2 relapsed withinthree months, two after 6 months, and six remained opioid-free. Seven patients of group 3 relapsed threemonths, one after 6 months and six patients remained opioid-free. In group 4, one patient relapsed within 3months and one patient after 6 months; 12 patients of this group remained opioid-free. At urine tests, asignificantly higher percent patients of group 4 remained free of D9-tetrahydrocannabinol versus patients of