***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 Results of pre clinical studies suggest that the GABAB receptor agonist baclofen may be useful in treatment of opioid dependence . This study was aim ed at assessing the possible efficacy of baclofen for maintenance treatment of opioid dependence . Methods A total of 40 opioid-dependent patients were detoxified and r and omly assigned to receive baclofen ( 60 mg/day ) or placebo in a 12-week , double blind , parallel-group trial . Primary outcome measure was retention in treatment . Secondary outcome measures included opioids and alcohol use according to urinalysis and self-report ratings , intensity of opioid craving assessed with a visual analogue scale , opioid withdrawal symptoms as measured by the Short Opiate Withdrawal Scale and depression scores on the Hamilton inventory . Results Treatment retention was significantly higher in the baclofen group . Baclofen also showed a significant superiority over placebo in terms of opiate withdrawal syndrome and depressive symptoms . Non-significant , but generally favorable responses were seen in the baclofen group with other outcome measures including intensity of opioid craving and self-reported opioid and alcohol use . However , no significant difference was seen in the rates of opioid-positive urine tests . Additionally , the drug side effects of the two groups were not significantly different . Conclusion The results support further study of baclofen in the maintenance treatment of opioid dependence Background : The clinical use of naltrexone ( NTX ) in the treatment of opioid dependence has been limited because of poor compliance and inconsistent outcomes . In particular , the therapeutic benefit of extended treatment with NTX after opioid detoxification is unclear . The present study evaluated whether the augmentation with low-dose NTX during the post-detoxification treatment of opioid dependence would improve outcomes . Methods : In an open-label naturalistic design , 435 opioid-dependent patients who had completed inpatient detoxification were offered the choice of entering 1 of the 2 outpatient treatment arms : clonidine extended treatment ( CET ) ( clonidine + psychosocial treatment ) , or enhanced extended treatment ( EET ) ( oral NTX [ 1 - 10 mg/d ] + CET ) for 21 days . The primary outcome measure was retention in treatment . Secondary outcomes included abstinence from opioids , dropouts , and adherence to postdischarge care . Results : One hundred sixty-two patients ( 37.2 % ) accepted EET . Subjects receiving EET  stayed longer in the program ( F = 64.4 ; P = 0.000 ) , were less likely to drop out , used less opioids , and followed through with referral to long-term outpatient treatment in a higher number , compared with patients in the CET arm ( P = 0.000 in each case ) . The NTX + clonidine combination was safe and well tolerated . Conclusions : This preliminary study indicates the potential benefit of augmentation with low-dose NTX to improve outcomes after opioid detoxification for a preferred group of patients . R and omized controlled trials are necessary to further evaluate the role of low-dose NTX in the outpatient treatment of opioid dependence CONTEXT The usual treatment for opioid-addicted youth is detoxification and counseling . Extended medication-assisted therapy may be more helpful . OBJECTIVE To evaluate the efficacy of continuing buprenorphine-naloxone for 12 weeks vs detoxification for opioid-addicted youth . DESIGN , SETTING , AND PATIENTS Clinical trial at 6 community programs from July 2003 to December 2006 including 152 patients aged 15 to 21 years who were r and omized to 12 weeks of buprenorphine-naloxone or a 14-day taper ( detox ) . INTERVENTIONS Patients in the 12-week buprenorphine-naloxone group were prescribed up to 24 mg per day for 9 weeks and then tapered to week 12 ; patients in the detox group were prescribed up to 14 mg per day and then tapered to day 14 . All were offered weekly individual and group counseling . MAIN OUTCOME MEASURE Opioid-positive urine test result at weeks 4 , 8 , and 12 . RESULTS The number of patients younger than 18 years was too small to analyze separately , but overall , patients in the detox group had higher proportions of opioid-positive urine test results at weeks 4 and 8 but not at week 12 ( chi(2)(2 ) = 4.93 , P = .09 ) . At week 4 , 59 detox patients had positive results ( 61 % ; 95 % confidence interval [ CI ] = 47%-75 % ) vs 58 12-week buprenorphine-naloxone patients ( 26 % ; 95 % CI = 14%-38 % ) . At week 8 , 53 detox patients had positive results ( 54 % ; 95 % CI = 38%-70 % ) vs 52 12-week buprenorphine-naloxone patients ( 23 % ; 95 % CI = 11%-35 % ) . At week 12 , 53 detox patients had positive results ( 51 % ; 95 % CI = 35%-67 % ) vs 49 12-week buprenorphine-naloxone patients ( 43 % ; 95 % CI = 29%-57 % ) . By week 12 , 16 of 78 detox patients ( 20.5 % ) remained in treatment vs 52 of 74 12-week buprenorphine-naloxone patients ( 70 % ; chi(2)(1 ) = 32.90 , P < .001 ) . During weeks 1 through 12 , patients in the 12-week buprenorphine-naloxone group reported less opioid use ( chi(2)(1 ) = 18.45 , P < .001 ) , less injecting ( chi(2)(1 ) = 6.00 , P = .01 ) , and less non study addiction treatment ( chi(2)(1 ) = 25.82 , P < .001 ) . High levels of opioid use occurred in both groups at follow-up . Four of 83 patients who tested negative for hepatitis C at baseline were positive for hepatitis C at week 12 . CONCLUSIONS Continuing treatment with buprenorphine-naloxone improved outcome compared with short-term detoxification . Further research is necessary to assess the efficacy and safety of longer-term treatment with buprenorphine for young individuals with opioid dependence . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00078130 It is estimated that more than 500 000 people in the United States are dependent on opioids [ 1 , 2 ] . Methadone , a synthetic opioid first reported as a treatment agent for opioid dependence by Dole and Nysw and er in 1965 [ 3 ] , is the most widely used pharmacologic treatment for opioid dependence . The National Drug and Alcoholism Treatment Unit Survey ( NDATUS ) determined a point prevalence of 92 715 opioid abusers treated in 758 methadone treatment programs on 30 September 1989 [ 4 ] . When used in conjunction with counseling services , methadone treatment has been associated with reduced rates of criminal activity , illicit drug use , and needle sharing and with improved rates of employment [ 5 - 9 ] . With the recognition of intravenous drug use as a primary risk factor for infection with human immunodeficiency virus ( HIV ) , improved access to methadone treatment has been identified as an important means for reducing the risk of HIV infection [ 10 , 11 ] . Although methadone treatment is effective in decreasing opioid use , recent studies have reported considerable variability across clinics in rates of continued intravenous drug use during treatment [ 12 ] . One aspect of this problem is that intravenous use of cocaine has become a serious problem among  methadone treatment patients [ 13 - 16 ] . Few systematic studies have addressed the efficacy of  methadone treatment since the onset of the cocaine epidemic [ 17 ] . Such research could re-evaluate in a contemporary population sample methadone 's specific pharmacologic efficacy in decreasing opioid use [ 18 - 20 ] while providing new information about any potential effect of methadone treatment on concurrent cocaine use . The issue of appropriate methadone dosing levels is highly pertinent because low-dose treatment has been strongly associated with poor drug use outcomes in descriptive clinical studies [ 12 , 21 ] and because a substantial number of clinics continue to use low doses of methadone [ 22 ] . For example , a report prepared by the General Accounting Office ( GAO ) that summarized the dosing practice s of 24 methadone programs in eight states found that doses ranged widely ( from 21 to 68 mg ) and 29 % had a mean dose of less than 40 mg [ 23 ] . Thus , despite more than 25 years of clinical experience , optimal dosing levels of methadone remain controversial [ 24 , 25 ] . Previous studies of methadone dosing have either surveyed clinics for their dosing practice and related doses to clinic-wide outcomes or have r and omly assigned patients to a specific predetermined dose of methadone using clinical trial methods . Naturalistic survey studies [ 5 , 6 , 12 , 21 , 26 ] , although valuable for identifying associations between dose and outcome , are method ologically compromised by confounding factors that differ across the clinics surveyed . Previous early clinical trials of methadone dosing [ 27 - 29 ] are also method ologically compromised ( for example , being single-blinded ) or only tested higher doses of methadone [ 30 ] . Thus there is a need for well-controlled research on methadone dosing reflecting doses in common use and incorporating the changing patient population . In this controlled clinical trial we compared moderate and low methadone dosing to methadone-free treatment , providing data in a contemporary population sample of opioid addicts and examining the effect of methadone dose on cocaine as well as opioid use . Methods Participants were 247 persons who had consecutive admissions to a methadone research clinic from September 1988 through July 1990 . The mean age was 34 years , 70 % were male , and 50 % were black . Most were unmarried ( 84 % ) and unemployed ( 62 % ) . They had an average of 11 years of education , were generally legally free ( 72 % ) , and had a mean of two previous admissions for drug abuse treatment . Their primary drug of choice was intravenous heroin , and 47 % reported using cocaine in the 30 days before their application to treatment . Eligibility criteria for study participation were age between 18 and 50 years , history of intravenous opioid dependence ( including documentation of previous treatment for opioid dependence or legal involvement secondary to opioid use , a urine sample positive for opioids , and physical examination consistent with acute and chronic needle use ) , no chronic medical illnesses , absence of a major mental illness , a negative pregnancy test for women , and at least 3 months since the patient 's last treatment at the clinic . Applicants who failed to fulfill the study 's eligibility criteria were assisted in seeking an alternate treatment program . The study was approved by the institutional review board , and informed consent was obtained from each patient at the time of admission to the study . Study Procedures Applicants who fulfilled the eligibility criteria were admitted to a 6-month short-term methadone treatment program .  Participants were stratified as to race and sex and were assigned to one of three fixed-dose methadone schedules ( Figure 1 ) . Treatment group assignment , stabilization doses , and dosing schedules were double-blind for all patients and the clinic staff who had patient contact . All patients received a minimum of 35 days of active methadone during the first 5 weeks of treatment ; this was followed by a 15-week stabilization period at either 50 , 20 , or 0 mg of methadone . Thus , patients assigned to the 0-mg treatment group received 35-day methadone detoxification . During weeks 21 through 26 , the methadone dose was gradually tapered for those patients still receiving active medication because this was a short-term ( 182-day ) treatment episode . A sub sample of patients ( n = 44 ) assigned to the 0-mg treatment group received a more prolonged ( 8-week ) induction period , reaching 0 mg at the start of week 9 to compare the effects of a faster to a slower detoxification protocol . In this report data for patients in the alternate 0-mg treatment groups are collapsed . Figure 1 . Dosing schedule . Treatment Procedures Patients were assigned an individual counselor who set treatment goals and developed an individualized treatment plan . Patients were given weekly group therapy focusing on relapse prevention . On-site medical services were provided by a full-time internist and a part-time nurse practitioner . Take-home medication was provided only on legal holidays and for documented extenuating circumstances ( for example , funeral out of town for a death in the family ) . Patients who failed to attend the clinic for 3 consecutive days were discharged from treatment . Outcome Measures Treatment Retention and Compliance Treatment retention was calculated as the total number of days between the day of admission and the day of discharge , or the last day of the stable dosing period ( day 140 ) if the patient remained in treatment beyond the stable dosing period . Compliance with treatment was assessed through treatment attendance , the number of days medicated divided by days in treatment , and counseling contacts 
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Comparisons showed a statistically significant difference between groups ; higher doses of buprenorphine increased the probability of retention in treatment .
It is not possible to conclude about the use of any kind of pharmacologic therapies for maintenance treatment of opium dependence