We found the article by Choudhry et al Reference Chaudhry, Sultan and Alam1 a very interesting read. Although retrospective, given a good sample size and appropriate period of follow up, the results are informative and useful. We applaud the effort to identify the subgroup of opiate-free patients who could benefit the most from naltrexone for relapse prevention.
It is striking that the study population had Asian men in such a high proportion, which certainly makes the sample atypical. The authors have mentioned the associated factors predicting a favourable outcome for this group. Could we request the authors to comment on the possible differences in naltrexone metabolism which might influence outcomes? There is now evidence to support the fact that pharmacogenetic characteristics of Asian population are associated with improved biobehavioural and clinical response to naltrexone. Reference Ray, Bujarski, Chin and Miotto2
The results might have further been affected by personality characteristics within the study group. This, too, would have been valuable information.
We also wondered why the naltrexone challenge was only done for 80.3% of the study sample. Information about how many failed the challenge would be useful as focusing only on the ones who were successful again selects the highly motivated group, which may not be representative. Finally, we wondered whether the authors might want to comment on the wider context given that the results have shown again that the retention rates in naltrexone treatment are not very high. It is worth noting that even if retained in treatment, efficacy of oral naltrexone in relapse prevention for opioid use is not significant Reference Minozzi, Amato, Vecchi, Davoli, Kirchmayer and Verster3 compared with placebo.
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