***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract . Background : This laboratory study investigated the mechanisms by which the opioid antagonist , naltrexone , reduces the risk of relapse to heavy drinking in individuals with alcohol dependence . Methods : Eighteen alcohol-dependent , non-treatment-seeking volunteers were r and omized to 50 mg naltrexone or placebo for 6 days and participated in an alcohol self-administration experiment on the sixth day . Following baseline assessment s of craving and endocrine levels , subjects were first administered a priming drink design ed to raise blood alcohol levels to 0.03 g/dl and then had the opportunity to drink up to eight additional drinks or to receive US $ 3 for each drink not consumed over a 2-h period . Each additional drink was design ed to raise blood alcohol levels by 0.015 g/dl . Results : At baseline , naltrexone treatment result ed in higher cortisol levels and lower levels of craving than placebo treatment . Although there were no significant differences in response to the priming dose , naltrexone-treated subjects drank fewer drinks , consumed them more slowly , and reported lower levels of alcohol craving during the alcohol self-administration portion of the experiment . Naltrexone also result ed in higher levels of adrenocorticotropic hormone and cortisol than placebo treatment , and levels of cortisol were negatively correlated with intensity of alcohol craving . The number of drinks chosen was positively correlated with level of alcohol craving . Ratings of nausea were low and did not differ between the naltrexone and placebo groups at any point in the study . Conclusions : These results confirm the hypothesis that naltrexone reduces desire to drink and the amount of alcohol consumed in alcohol-dependent subjects . It is hypothesized that naltrexone may reduce drinking via suppressing craving for alcohol and that this effect may be related in part to naltrexone 's ability to activate the hypothalamo – pituitary – adrenocortical axis BACKGROUND Environmental stimuli associated with drug taking have been known to elicit drug craving and physiologic arousal , as well as hypothalamic-pituitary-adrenal axis activation . However , the relationship between these responses and substance use outcomes in heroin-dependent subjects has not been previously studied . We investigated the relationship among subjective and physiologic reactivity , biological stress response evoked in the laboratory , and relapse to substance use in treated opiate-dependent individuals . METHODS Eighteen opiate-abstinent methadone- or buprenorphine-treated patients and 13 control subjects were exposed to neutral- and drug-cue exposure laboratory sessions with a 3-month follow-up period . Exposure to cues involved both videotapes and h and ling during a 100-min session . Subjective craving , agonistic effects , withdrawal feelings , galvanic skin resistance , and salivary cortisol were assessed . Substance use outcome among patients was examined during the follow-up phase . Differences between relapsers , nonrelapsers , and controls were analyzed with respect to the data on drug-cue responsivity and on cortisol responses using repeated- measures analysis of variance . The association with substance use outcome was assessed using a nominal logistic model . RESULTS Relapsers experienced greater drug-cue induced subjective responses and an increased cortisol response compared with both nonrelapsers and control subjects . After adjusting on covariates , cue-induced cortisol response was associated with the relapser group and was highly correlated with self-reports of " high . " CONCLUSIONS Subjects defined as relapsers presented a higher cue-induced reactivity during the drug-cue exposure as well as an increased cortisol response to drug cues . Higher cortisol response to drug cues may increase relapse vulnerability in stable-dose buprenorphine or methadone-maintained subjects BACKGROUND The partial opiate-receptor agonist buprenorphine has been suggested for treatment of heroin dependence , but there are few long-term and placebo-controlled studies of its effectiveness . We aim ed to assess the 1-year efficacy of buprenorphine in combination with intensive psychosocial therapy for treatment of heroin dependence . METHODS 40 individuals aged older than 20 years , who met DSM-IV criteria for opiate dependence for at least 1 year , but did not fulfil Swedish legal criteria for methadone maintenance treatment were r and omly allocated either to daily buprenorphine ( fixed dose 16 mg sublingually for 12 months ; supervised daily administration for a least 6 months , possible take-home doses thereafter ) or a tapered 6 day regimen of buprenorphine , thereafter followed by placebo . All patients participated in cognitive-behavioural group therapy to prevent relapse , received weekly individual counselling sessions , and su bmi tted thrice weekly supervised urine sample s for analysis to detect illicit drug use . Our primary endpoint was 1-year retention in treatment and analysis was by intention to treat . FINDINGS 1-year retention in treatment was 75 % and 0 % in the buprenorphine and placebo groups , respectively ( p=0.0001 ; risk ratio 58.7 [ 95 % CI 7.4 - 467.4 ] ) . Urine screens were about 75 % negative for illicit opiates , central stimulants , cannabinoids , and benzodiazepines in the patients remaining in treatment . INTERPRETATION The combination of buprenorphine and intensive psychosocial treatment is safe and highly efficacious , and should be added to the treatment options available for individuals who are dependent on heroin 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 CONTEXT Rapid opioid detoxification with opioid antagonist induction using general anesthesia has emerged as an expensive , potentially dangerous , unproven approach to treat opioid dependence . OBJECTIVE To determine how anesthesia-assisted detoxification with rapid antagonist induction for heroin dependence compared with 2 alternative detoxification and antagonist induction methods . DESIGN , SETTING , AND PATIENTS A total of 106 treatment-seeking heroin-dependent patients , aged 21 through 50 years , were r and omly assigned to 1 of 3 inpatient withdrawal treatments over 72 hours followed by 12 weeks of outpatient naltrexone maintenance with relapse prevention psychotherapy . This r and omized trial was conducted between 2000 and 2003 at Columbia University Medical Center 's Clinical Research Center . Outpatient treatment occurred at the Columbia University research service for substance use disorders . Patients were included if they had an American Society of Anesthesiologists physical status of I or II , were without major comorbid psychiatric illness , and were not dependent on other drugs or alcohol . INTERVENTIONS Anesthesia-assisted rapid opioid detoxification with naltrexone induction , buprenorphine-assisted rapid opioid detoxification with naltrexone induction , and clonidine-assisted opioid detoxification with delayed naltrexone induction . MAIN OUTCOME MEASURES Withdrawal severity scores on objective and subjective scales ; proportions of patients receiving naltrexone , completing inpatient detoxification , and retained in treatment ; proportion of opioid-positive urine specimens . RESULTS Mean withdrawal severities were comparable across the 3 treatments . Compared with clonidine-assisted detoxification , the anesthesia- and buprenorphine-assisted detoxification interventions had significantly greater rates of naltrexone induction ( 94 % anesthesia , 97 % buprenorphine , and 21 % clonidine ) , but the groups did not differ in rates of completion of inpatient detoxification . Treatment retention over 12 weeks was not significantly different among groups with 7 of 35 ( 20 % ) retained in the anesthesia-assisted group , 9 of 37 ( 24 % ) in the buprenorphine-assisted group , and 3 of 34 ( 9 % ) in the clonidine-assisted group . Induction with 50 mg of naltrexone significantly reduced the risk of dropping out ( odds ratio , 0.28 ; 95 % confidence interval , 0.15 - 0.51 ) . There were no significant group differences in proportions of opioid-positive urine specimens . The anesthesia procedure was associated with 3 potentially life-threatening adverse events . CONCLUSION These data do not support the use of general anesthesia for heroin detoxification and rapid opioid antagonist induction Detoxification was studied in well-rehabilitated , selected , methadone-maintained patients . Seventy-nine percent of 48 patients were successfully detoxified , functioned well , and were apparently drug-free when studied months after their last methadone treatment . Twenty-one percent returned to methadone maintenance treatment because of heroin use or the withdrawal syndrome . Other patients could not be detoxified , even in a slow , flexible dose-reduction regimen . It is recommended that the primary aim of methadone treatment is to facilitate rehabilitation . Decisions regarding detoxification should be made by the physician on an individual basis , after a year or more of successful treatment after weighing the degree of rehabilitation , relapse potential , and the patient 's wishes CONTEXT No r and omized trials have examined treatments for prescription opioid dependence , despite its increasing prevalence . OBJECTIVE To evaluate the efficacy of brief and extended buprenorphine hydrochloride-naloxone hydrochloride treatment , with different counseling intensities , for patients dependent on prescription opioids . DESIGN Multisite , r and omized clinical trial using a 2-phase adaptive treatment research design . Brief treatment ( phase 1 ) included 2-week buprenorphine-naloxone stabilization , 2-week taper , and 8-week postmedication follow-up .  Patients with successful opioid use outcomes exited the study ; unsuccessful patients entered phase 2 : extended ( 12-week ) buprenorphine-naloxone treatment , 4-week taper , and 8-week postmedication follow-up . SETTING Ten US sites . Patients A total of 653 treatment-seeking out patients dependent on prescription opioids . INTERVENTIONS In both phases , patients were r and omized to st and ard medical management ( SMM ) or SMM plus opioid dependence counseling ; all received buprenorphine-naloxone . MAIN OUTCOME MEASURES Predefined " successful outcome " in each phase : composite measures indicating minimal or no opioid use based on urine test-confirmed self-reports . RESULTS During phase 1 , only 6.6 % ( 43 of 653 ) of patients had successful outcomes , with no difference between SMM and SMM plus opioid dependence counseling . In contrast , 49.2 % ( 177 of 360 ) attained successful outcomes in phase 2 during extended buprenorphine-naloxone treatment ( week 12 ) , with no difference between counseling conditions . Success rates 8 weeks after completing the buprenorphine- 
    Output:
    
Results indicate that maintenance medication provides the best opportunity for patients to achieve recovery from opiate addiction .
Extensive literature and systematic review s show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment , reduction in illicit opiate use , decreased craving , and improved social function .
Oral naltrexone is ineffective in treating opiate addiction , but recent studies using extended-release naltrexone injections have shown promise .
Although no direct comparisons between extended-release naltrexone injections and either methadone or buprenorphine exist , indirect comparison of retention shows inferior outcome compared with methadone and buprenorphine .