randomly assigned federal probationers to a 6-month program of probation plus naltrexone and brief drug counseling or to probation plus counseling alone and found that opioid use was significantly lower in the naltrexone group, with the mean percent of opioid positive urine tests among the naltrexone subjects at 8%, versus 30% for control subjects ( p <. However, it is typically taken orally on a daily basis, making adherence a problem among all but the most committed patients. This characteristic has fostered growing acceptance of naltrexone by correctional authorities who prefer not to provide opioid agonist treatment with medications such as methadone or buprenorphine. Naltrexone, an opioid receptor antagonist, blocks the euphoric effects of heroin and other opioids. The efficacy of naltrexone in the treatment of opioid dependence has been well established. A study of newly released prisoners in England and Wales found that mortality rates among males were 29 times higher than the general population during the first two weeks of release. As dire as this finding is, it may be an underestimate of the problem. Likewise, the risk of death among parolees during the first two weeks following release from prison is nearly 13 times greater than those of similar demographic background-with drug overdose being the leading cause. In a given year, a quarter of all people in the United States who have HIV, a third who have HCV infection, and more than 40% who have tuberculosis disease will pass through a correctional facility that same year.
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