***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Expansion of access to effective treatments for heroin dependence is a worldwide health priority that will also reduce HIV transmission . We compared the efficacy of naltrexone , buprenorphine , and no additional treatment , in patients receiving detoxification and subsequent drug counselling , for maintenance of heroin abstinence , prevention of relapse , and reduction of HIV risk behaviours . METHODS 126 detoxified heroin-dependent patients , from an outpatient research clinic and detoxification programme in Malaysia , were r and omly assigned by a computer-generated r and omisation sequence to 24 weeks of manual-guided drug counselling and maintenance with naltrexone ( n=43 ) , buprenorphine ( n=44 ) , or placebo ( n=39 ) . Medications were administered on a double-blind and double-dummy basis . Primary outcomes , assessed by urine testing three times per week , were days to first heroin use , days to heroin relapse ( three consecutive opioid-positive urine tests ) , maximum consecutive days of heroin abstinence , and reductions in HIV risk behaviours over 6 months . The study was terminated after 22 months of enrolment because buprenorphine was shown to have greater efficacy in an interim safety analysis . Analysis was by intention to treat . This study is registered with Clinical Trials.gov , number NCT00383045 . FINDINGS We observed consistent , linear contrasts in days to first heroin use ( p=0.0009 ) , days to heroin relapse ( p=0.009 ) , and maximum consecutive days abstinent ( p=0.0007 ) , with all results best for buprenorphine and worst for placebo . Buprenorphine was associated with greater time to first heroin use than were naltrexone ( hazard ratio 1.87 [ 95 % CI 1.21 - 2.88 ] ) or placebo ( 2.02 [ 1.29 - 3.16 ] ) . With buprenorphine , we also recorded significantly greater time to heroin relapse ( 2.17 [ 1.38 - 3.42 ] ) , and maximum consecutive days abstinent than with placebo ( mean days 59 [ 95 % CI 43 - 76 ] vs 24 [ 13 - 35 ] ; p=0.003 ) ; however , for these outcomes , differences between buprenorphine and naltrexone were not significant . Differences between naltrexone and placebo were not significant for any outcomes . HIV risk behaviours were significantly reduced from baseline across all three treatments ( p=0.003 ) , but the reductions did not differ significantly between the three groups . INTERPRETATION Our findings lend support to the widespread dissemination of maintenance treatment with buprenorphine as an effective public-health approach to reduce problems associated with heroin dependence Federal probationers or parolees with a history of opioid addiction were referred by themselves or their probation/parole officer for a naltrexone treatment study . Participation was voluntary and subjects could drop out of the study at any time without adverse consequences . Following orientation and informed consent , 51 volunteers were r and omly assigned in a 2:1 ratio to a 6-month program of  probation plus naltrexone and brief drug counseling , or probation plus counseling alone . Naltrexone subjects received medication and counseling twice a week ; controls received counseling at similar intervals . All therapy and medication were administered in an office located adjacent to the federal probation department . Fifty-two percent of subjects in the naltrexone group continued for 6 months and 33 % remained in the control group . Opioid use was significantly lower in the naltrexone group . The overall mean percent of opioid positive urine tests among the naltrexone subjects was 8 % , versus 30 % for control subjects ( p < .05 ) . Fifty-six percent of the controls and 26 % of the naltrexone group ( p < .05 ) had their probation status revoked within the 6-month study period and returned to prison . Treatment with naltrexone and brief drug counseling can be integrated into the Federal Probation/Parole system with favorable results on both opioid use and re-arrest rates The goals of this study were two-fold : ( 1 ) to test the hypothesis that retention of patients in naltrexone treatment could be improved by educating and preparing them for it while enrolled in a LAAM ( l-alpha-acetylmethadol ) detoxification program ; and ( 2 ) to compare the safety and efficacy of 60 mg vs. 120 mg administered thrice weekly in a double-blind , sequential trial design . Patients were allowed a maximum of 365 days on naltrexone , and a maximum of four admissions ; 119 patients received at least one dose of naltrexone .  We found no clinical ly important differences between the two dosages , and retention in treatment was similar to that reported in earlier clinical trials . Slightly more than half the patients ever used heroin while receiving naltrexone , and only 9 % of all urine tests were positive for opiates . Craving for heroin decreased dramatically by the end of the first week . We found no side-effect or toxicity due to naltrexone AIM To investigate the efficacy of low doses of naltrexone in relapse prevention for heroin dependence . DESIGN Double blind , r and omised comparison of three groups-Group 1 taking 50 mg per day , Group 2 : 0.5 mg per day , and Group 3 : 0.05 mg per day . PARTICIPANTS Sixty-six dependent heroin users . INTERVENTIONS After detoxification followed by 1 week on 50 mg per day naltrexone , participants were r and omised to trial medication . All were offered counselling and monitored with weekly clinical review s. Research interviews were conducted at three and 6 months . OUTCOME MEASURES Retention in treatment and heroin use at 3 and 6 months . Secondary outcome measures were side effects and craving . FINDINGS Mean days retained in r and omised treatment were-Group 1 : 58.9 days ; Group 2 : 46.6 days ; and Group 3 : 47.8 days . Differences in retention were not significant using survival analysis . However , nine of the first 60 participants , transferred to the 50 mg dose , and one transferred to a lower dose ( chi-square = 0.142 ; P = 0.018 ) . At follow-up , there was no relationship between abstinence from heroin and naltrexone dose , nor between level of heroin use and dose . There were no differences between groups in craving or depression . CONCLUSION Low doses of naltrexone had no discernible advantage , and participants preferred 50 mg per day . Despite preference for blocking doses of naltrexone , outcomes appeared to be independent of naltrexone dose The effectiveness of antagonist maintenance with oral naltrexone for opioid dependence has been limited by high dropout rates . Behavioral Naltrexone Therapy ( BNT ) was developed to improve retention on oral naltrexone by integrating voucher incentives , Motivational and Cognitive Behavioral therapies , and a significant other for monitoring medication adherence . In a 6-month , r and omized , controlled trial in heroin dependent patients , BNT ( N = 36 ) improved retention in treatment compared to a st and ard treatment control ( Compliance Enhancement ( CE ) ; N = 33 ) ( log rank = 4.28 ; p = .04 ) . Most patients retained beyond 3 months achieved abstinence from opioids , but retention at 6 months was only 22 % on BNT and 9 % on CE . A systematic review of related controlled trials revealed similar effect sizes in the small to medium range , and substantial dropout . There may be a limit on the extent to which behavioral therapy can overcome poor adherence to oral naltrexone . Future research should consider combinations of behavioral methods with new long-acting injectable or implantable naltrexone formulations In a double blind study , out of 31 newly abstinent patients who underwent opioid free detoxification , 15 were started on the opiate antagonist Naltrexone for 2 months , and 16 were put on  placebo  for the same period . Given Naltrexone 's known efficacy in blocking euphorigenic effects of opioid intake , and in decreasing cravings for the drug , the authors have tried to assess eventual drug taking , specifically in the context of suburban housing projects , and evaluate the rate of retention in a rehabilitative program for both the Naltrexone and placebo groups . An Opioid free condition was followed up for a year , also respecting double blind conditions . Naltrexone did not appear to be superior to the placebo with regards to retention rate . In the Naltrexone group ( n = 15 ) , 9 finished the two-month treatment , and 8 remained opioid-free for a year . In the placebo group ( n = 16 ) , 8 finished the 2 month trial and 6 remained opioid-free for a year . Naltrexone blocked opioid-induced euphoria and decreased the craving for opium , but it did not inhibit drug usage . The retention rate registered during the course of the study , as well as an opioid-free condition in the follow-up year , correlated with a patient profile defined by good social functioning and stable relationships . The inherent method ological limitations of this study did not allow for the discrimination of the role of non-pharmacological factors , such as psychotherapy , supportive family framework , community assistance , and staff motivation , concerning the clinical results . Further investigation of Naltrexone in larger sample s is needed Naltrexone and placebo as adjuvant treatment of opioid dependence were compared in a double-blind , controlled clinical trial in 50 heroin addicts . The overall efficacy was assessed by the degree of treatment acceptance , percentage of relapse in heroin consumption , presence of side effects , and overall retention on naltrexone .  A total of 50 patients of both sexes , aged from 18 to 30 years , who fulfilled DSM-III-R criteria for opioid dependence were included in the study . All patients completed detoxification with clonidine on an inpatient basis for 2 weeks and subsequently , on an out-patient basis , received oral naltrexone ( 350 mg per week ) for a month . At the beginning of the second month patients were r and omly allocated to treatment with naltrexone ( 28 patients ) or placebo ( 22 patients ) until a 6-month treatment period in a double-blind fashion had been completed . During the study period ( 1 year ) all patients followed the same therapeutic schedule . Patients in both groups were comparable in terms of socio-demographic data and toxicological history . The efficacy of naltrexone was not superior to that of placebo as there were no significant differences in acceptance of treatment , retention rates , opioid and other drug consumption , drug compliance or side effects This r and omized placebo-controlled trial tested the efficacy of oral naltrexone with or without fluoxetine for preventing  relapse to heroin addiction and for reducing HIV risk , psychiatric symptoms , and outcome . All patients received drug counseling with parental or significant-other involvement to encourage adherence . Patients totaling 414 were approached , 343 gave informed consent , and 280 were r and omized ( mean age , 23.6 + /- 0.4 years ) . At 6 months , two to three times as many naltrexone patients as naltrexone placebo patients remained in treatment and had not relapsed , odds ratio ( OR ) = 3.5 ( 1.96 - 6.12 ) , p < .0001 . Overall , adding fluoxetine did not improve outcomes , OR = 1.35 ( 0.68 - 2.66 ) , p = .49 ; however , women receiving naltrexone and fluoxetine showed a trend toward a statistically significant advantage when compared to women receiving naltrexone and fluoxetine placebo , OR = 2.4 ( 0.88 - 6.59 ) , p = .08 . HIV risk , psychiatric symptoms , and overall adjustment were markedly improved among all patients who remained on treatment and did not relapse , regardless of group assignment . More widespread use of naltrexone could be an important addition to addiction treatment and HIV prevention in Russia The efficacy of Naltrexone in preventing reabuse of heroin among heroin addicts in Israel was studied in a double-blind , controlled design . Naltrexone ( or placebo ) treatment was given as part of a general treatment plan that continued for 12 weeks . Thirty-two addicts who successfully completed a detoxification program and met research criteria , were included in the study .  Fifty milligrams of Naltrexone were taken orally three times a week ( 25 mg twice a week for the first 2 weeks ) . The follow-up procedure included an  interview , urine tests  , and  screening  for possible adverse effects . In addition , social and psychological parameters were evaluated . Fewer heroin-positive urine tests were found the Naltrexone group than in the placebo group . Throughout the entire study , the number of drug-free patients in the Naltrexone group was higher than in the placebo group . The Naltrexone group showed a significant improvement in most psychological parameters as compared with the placebo group . No differences were found in compliance or ratio of adverse effects between the Naltrexone and placebo groups . The concept " heroin abuse load " based on daily heroin consumption and duration of addiction enabled us to predict which addicts would complete the treatment program . The results suggest that heroin addicts in Israel may benefit from treatment with Naltrexone Good results in detoxification methods have been reached using both together clonidine and op 
    Output:
    
Naltrexone was not superior to benzodiazepines and to buprenorphine for retention and abstinence and side effects .
The findings of this review suggest that oral naltrexone did not perform better than treatment with placebo or no pharmacological agent with respect to the number of participants re-incarcerated during the study period .
If oral naltrexone is compared with other pharmacological treatments such as benzodiazepine and buprenorphine , no statistically significant difference was found .
The conclusion of this review is that the studies conducted have not allowed an adequate evaluation of oral naltrexone treatment in the field of opioid dependence .
Consequently , maintenance therapy with naltrexone can not yet be considered a treatment which has been scientifically proved to be superior to other kinds of treatment