Faculty Bibliography

Naltrexone, an orally administered, synthetic, long-acting narcotic antagonist, is being reviewed by the Food and Drug Administration (FDA). Specifically, the FDA is reviewing the preclinical (toxicology, reproduction and teratology, and carcinogenicity studies) and clinical (Phase I, Phase II, and Phase III) data to determine if the drug is safe and effective. When the New Drug Application (NDA) is approved, naltrexone will be available as an unscheduled prescription medication, useful as an adjunct in the maintenance of an opioid dependence-free state in former narcotic abusers. FDA approval of naltrexone for marketing will conclude more than three and a half decades of research on narcotic antagonists by the National Institute on Drug Abuse (NIDA) and its predecessors

Naltrexone was administered to 114 opiate-dependent business executives and 15 opiate-dependent physicians as part of a comprehensive outpatient aftercare program following inpatient detoxification using clonidine. Over 80% of patients successfully completed at least 6 months of treatment without relapse or re-addiction and were still drug-free at 12-18 month follow-up. Patients who completed at least 6 months of treatment were more likely to be opiate free at follow-up than patients who had dropped out at an earlier point in the program. This study demonstrates that naltrexone can be an extremely useful and appropriate treatment for highly motivated middle/upper class addicts when administered within the context of an intensive high-expectation program

Seventy upper-income cocaine users who called the 800-COCAINE helpline received an extensive telephone interview to assess the nature, extent, and consequences of their cocaine use. The data revealed a high incidence of dysfunctional cocaine use associated with numerous physical, psychological, and social problems. Comparison with an earlier study of middle-income cocaine users highlights the role of drug access as a contributor to intensified use patterns and drug-related consequences. Issues pertaining to treatment of the upper-income cocaine abuser are discussed

Five hundred cocaine users who called the 800-COCAINE helpline received an extensive telephone interview to assess the nature, extent and consequences of their self-reported cocaine use. The data revealed a high incidence of dysfunctional cocaine use associated with numerous physical, psychological, and social problems. The typical caller was a white, middle-income male between 25 and 40 years old with no history of drug dependency or serious psychiatric problems. The findings are discussed with regard to the high abuse potential of cocaine and other factors that lead to problematic use and adverse effects

Naltrexone was administered to 114 opiate-dependent business executives and 15 opiate-dependent physicians as part of a comprehensive outpatient aftercare program following inpatient detoxification using clonidine. Over 80% of patients successfully completed at least six months of treatment without relapse or re-addiction and were still drug-free at 12-18 months follow-up. Patients who completed at least six months of treatment were more likely to be opiate free at follow-up than patients who had dropped out at an earlier point in the program. This study demonstrates that naltrexone can be an extremely useful and appropriate treatment for highly motivated middle/upper class addicts when administered within the context of an intensive high-expectation program

Forty-four consecutive outpatients referred to a psychiatric hospital for evaluation of depression and anergia were assessed by means of the protirelin (thyrotropin-releasing hormone) test. Nineteen patients (43%) had a blunted thyrotropin (TSH) response to protirelin, while six patients (13.5%) had augmented TSH responses indicating some degree of hypothyroidism. One patient had a low thyroxine level, while three patients had elevated basal TSH levels. Five of the six patients with augmented TSH responses were found to have antithyroid antibodies. These results suggest that a majority of depressed outpatients have abnormalities on the protirelin test and that the TSH response to protirelin is useful in both confirming a diagnosis of major depression and assessing thyroid status