Course of weight change during naltrexone versus methadone maintenance for opioid-dependent patients

David J. Mysels, MD, MBA; Suzanne K. Vosburg, PhD; Ileana Benga, MD; Frances R. Levin, MD; Maria A. Sullivan, MD, PhD

doi:10.5055/jom.2011.0048

Authors

David J. Mysels, MD, MBA
Suzanne K. Vosburg, PhD
Ileana Benga, MD
Frances R. Levin, MD
Maria A. Sullivan, MD, PhD

DOI:

https://doi.org/10.5055/jom.2011.0048

Keywords:

methadone, naltrexone, weight gain, opiate dependence

Abstract

Background: μ-Opiate receptor agonism has been associated with weight gain, whereas μ-antagonists have been associated with weight neutrality, or even weight loss.
Aim: This study examined the course of weight changes in opiate-dependent patients over the first 6 months of treatment in methadone (agonist) versus naltrexone (antagonist) maintenance.
Design: A retrospective chart review was conducted on 36 opiate-dependent patients maintained on methadone (n = 16) or naltrexone (n = 20). Outcome measures and analyses: The primary outcome measure was change in body weight from baseline to 3 months and 6 months into treatment. Analysis of variance was used to compare mean weights between the methadone- and naltrexone-maintained patients. Secondarily, mean percent weight changes from baseline to 3 months and from baseline to 6 months into treatment were compared using Student’s t-test.
Results: There was no difference between weight at baseline, 3 months, or 6 months into treatment between the two treatment groups. Furthermore, there was also no difference between the two groups regarding percent weight change from baseline to 3 months or baseline to 6 months. At 3 months, n = 16 methadone patients had a mean weight increase of 1.86 percent (standard deviation [SD] = 7.22 percent) when compared with n = 20 Behavioral Naltrexone Therapy (BNT) patients with an increase of 4.63 percent (SD = 6.49 percent). At 6 months, n = 16 methadone patients had a mean weight increase relative to baseline of 3.67 percent (SD = 9.52 percent) when compared with n = 20 BNT patients, who demonstrated a mean increase of 6.69 percent (SD = 7.56 percent). No association was found between baseline weight, defined as “low” or “high” relative to group medians, and percent gain within and between treatment groups.
Conclusions: This study did not detect a statistically different course of weight gain between methadone and naltrexone maintenance treatment for opiate-dependent patients.

Author Biographies

David J. Mysels, MD, MBA

Clinical Research Fellow, Division of Addiction Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Division of Substance Abuse Research, New York State Psychiatric Institute, New York, New York; Instructor of Psychiatry, Harvard Medical School, Boston, Massachusetts; Outpatient Addiction Psychiatrist, Cambridge Health Alliance, Cambridge, Massachusetts.

Suzanne K. Vosburg, PhD

Assistant Professor of Clinical Neuroscience, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Research Scientist, Division of Substance Abuse Research, New York State Psychiatric Institute, New York, New York.

Ileana Benga, MD

Clinical Assistant Professor of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Medical Director of the Opioid Treatment Program, Addiction Institute of New York/St. Luke’s-Roosevelt Hospital, New York, New York.

Frances R. Levin, MD

Kennedy Leavy Professor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Division of Substance Abuse Research, Columbia University/New York State Psychiatric Institute, New York, New York.

Maria A. Sullivan, MD, PhD

Associate Professor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Division of Substance Abuse Research, New York State Psychiatric Institute New York, New York.

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