Nikolaj Kunøe

• Rustad Indregard, Anne Marthe; Nussle, Hans Martin; Småstuen, Milada Cvancarova; Vandvik, Per Olav; Tesli, Martin Steen & Gather, Jakov [Vis alle 7 forfattere av denne artikkelen] (2024). Open-door policy versus treatment-as-usual in urban psychiatric inpatient wards: a pragmatic, randomised controlled, non-inferiority trial in Norway. The Lancet Psychiatry. ISSN 2215-0374. doi: 10.1016/S2215-0366(24)00039-7.
• Opheim, Arild; Saltyte Benth, Jurate; Solli, Kristin Klemmetsby; Kloster, Pia Synnøve; Fadnes, Lars T. & Kunøe, Nikolaj [Vis alle 8 forfattere av denne artikkelen] (2023). Risk of relapse to non-opioid addictive substances among opioid dependent patients treated with an opioid receptor antagonist or a partial agonist: A randomized clinical trial. Contemporary Clinical Trials. ISSN 1551-7144. 135. doi: 10.1016/j.cct.2023.107360. Fulltekst i vitenarkiv
• Kunøe, Nikolaj; Antonsen, Bjørnar Torske; Ebeling, Benjamin & Bruun, Sissel (2022). Kortvarige brukerstyrte innleggelser som alternativ til tvangsinnleggelse hos pasienter med alvorlig selvskading. Tidsskrift for Norsk Psykologforening. ISSN 0332-6470. 59(6), s. 548–557. doi: 10.52734/6MP76v23.
• Kunøe, Nikolaj; Nussle, Hans Martin & Rustad Indregard, Anne Marthe (2022). Protocol for the Lovisenberg Open Acute Door Study (LOADS): A pragmatic randomised controlled trial to compare safety and coercion between open-door policy and usual-care services in acute psychiatric inpatients. BMJ Open. ISSN 2044-6055. 12(2). doi: 10.1136/bmjopen-2021-058501.
• Gaulen, Zhanna; Brenna, Ida Halvorsen; Fadnes, Lars T.; Saltyte Benth, Jurate; Solli, Kristin Klemmetsby & Kunøe, Nikolaj [Vis alle 8 forfattere av denne artikkelen] (2021). The Predictive Value of Degree of Preference for Extended-Release Naltrexone for Treatment Adherence, Opioid Use, and Relapse. European Addiction Research. ISSN 1022-6877. 28(1). doi: 10.1159/000518436.
• Opheim, Arild; Gaulen, Zhanna; Solli, Kristin Klemmetsby; Latif, Zill-E-Huma; Fadnes, Lars T. & Saltyte Benth, Jurate [Vis alle 8 forfattere av denne artikkelen] (2021). Risk of Relapse Among Opioid-Dependent Patients Treated With Extended-Release Naltrexone or Buprenorphine-Naloxone: A Randomized Clinical Trial. American Journal on Addictions. ISSN 1055-0496. 30(5), s. 453–460. doi: 10.1111/ajad.13151. Fulltekst i vitenarkiv Vis sammendrag

  Background and Objectives Compare the risk of relapse to heroin and other illicit opioids among opioid-dependent patients receiving treatment with extended-release naltrexone (XR-NTX) or buprenorphine-naloxone (BP-NLX). Methods Re-analyzed data from a 12-week multicenter, open-label, randomized treatment study with a subsequent 36-week open-label follow-up study. All patients, N = 143, had completed detoxification and received at least one dose of study medication. Results Of 143 patients (72% men), mean age 36 years, 71 received XR-NTX and 72 BP-NLX. The risk of first relapse and the risk of any relapse to heroin and other illicit opioids were both significantly lower in the XR-NTX group compared with the BP-NLX group (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.28-0.76; P = .002, and HR, 0.11; 95% CI, 0.04-0.29; P < .001, respectively) and (HR, 0.15; 95% CI, 0.09-0.27; P < .001 and HR, 0.05; 95% CI, 0.03-0.09; P < .001, respectively). There was a stable low risk of relapse among participants receiving XR-NTX in the follow-up. Discussion and Conclusions Compared to BP-NLX, patients on XR-NTX had a substantially reduced risk of relapse to illicit opioids and showed a stable low risk of relapse over time in longer-term treatment. Scientific Significance Our data support XR-NTX as a first-line treatment option for patients with opioid addiction both in short and longer-term treatment. This is the first European study showing that XR-NTX significantly reduces the risk of first and any relapse to heroin use in opioid-dependent patients compared to BP-NLX. Our data contradict previous data from the X:BOT study, showing no significant difference in relapse risk between the groups in a 6-month randomised controlled trial.

• Solli, Kristin Klemmetsby; Opheim, Arild; Latif, Zill-E-Huma; Krajci, Peter; Saltyte Benth, Jurate & Kunøe, Nikolaj [Vis alle 7 forfattere av denne artikkelen] (2020). Adapting treatment length to opioid-dependent individuals' needs and preferences: A 2-year follow-up to a 1-year study of extended-release naltrexone. Addiction. ISSN 0965-2140. s. 1–10. doi: 10.1111/add.15378. Fulltekst i vitenarkiv Vis sammendrag

  Background and aim: Extended-release naltrexone (XR-NTX) is an underused treatment option for opioid dependence, today only available in a few countries in the world. Although effective, safe and feasible in short-term treatment, long-term data are scarce and there is no recommendation for required treatment length. The aims of the study were to determine the perceived need of long-term XR-NTX treatment and to examine long-term treatment outcomes. Design: In this prospective cohort study, following a parent 1-year study of XR-NTX, participants received treatment with XR-NTX at their own discretion for a maximum of 104 weeks. Setting: Five urban, outpatient addiction clinics in Norway. Participants: Opioid-dependent adults 18-60 years old (n=50) already participating in the parent study. Intervention: XR-NTX administrated as intra-muscular injections (380 mg) every 4 weeks. Measurements: Time in the study, use of opioids and other illicit substances, opioid craving, and treatment satisfaction reported every 4 weeks. Findings: Among 58 participants who completed the 1-year parent study, 50 chose to continue the treatment with XR-NTX. Median prolonged treatment time was 44.0 weeks (95% CI: 25.5-62.5), ranging from 8 to 104 weeks. Most participants (35, 70%) reported no relapse to opioid use during treatment while a subgroup (15, 30%) reported relapses to opioids during the study. Scores for mean treatment satisfaction and recommending treatment to others were very high (>9) and mean opioid craving score was very low (<1) on a scale ranging from 0 to 10. Conclusions: Extended-release naltrexone (XR-NTX) was well tolerated in long-term treatment of opioid dependent individuals in Norway already in XR-NTX treatment. On average, the participants chose to continue treatment for almost 1 year beyond the initial 9 to 12 months of treatment. Participants reported high treatment satisfaction and 70% showed no relapse to opioids during the treatment period. Keywords: Extended-release naltrexone; antagonist treatment; long-term treatment; opioid use; recovery; treatment duration; treatment of opioid dependence.

• Eikemo, Marie; Lobmaier, Philipp Paul; Pedersen, Mads Lund; Kunøe, Nikolaj; Matziorinis, Anna Maria & Leknes, Siri [Vis alle 7 forfattere av denne artikkelen] (2019). Intact responses to non-drug rewards in long-term opioid maintenance treatment. Neuropsychopharmacology. ISSN 0893-133X. 44(8), s. 1456–1463. doi: 10.1038/s41386-019-0377-9. Fulltekst i vitenarkiv
• Solli, Kristin Klemmetsby; Kunøe, Nikolaj; Latif, Zill-E-Huma; Haase, Kamni Sharma; Opheim, Arild & Krajci, Peter [Vis alle 9 forfattere av denne artikkelen] (2019). Availability of extended-release naltrexone may increase the number of opioid-dependent individuals in treatment: Extension of a randomized clinical trial. European Addiction Research. ISSN 1022-6877. 25(6), s. 1–7. doi: 10.1159/000501931. Fulltekst i vitenarkiv
• Latif, Zill-E-Huma; Solli, Kristin Klemmetsby; Opheim, Arild; Kunøe, Nikolaj; Saltyte Benth, Jurate & Krajci, Peter [Vis alle 8 forfattere av denne artikkelen] (2019). No increased pain among opioid-dependent individuals treated with extended-release naltrexone or buprenorphine-naloxone: A 3-month randomized study and 9-month open-treatment follow-up study. American Journal on Addictions. ISSN 1055-0496. 38(2), s. 77–85. doi: 10.1111/ajad.12859.
• Latif, Zill-E-Huma; Saltyte Benth, Jurate; Solli, Kristin Klemmetsby; Opheim, Arild; Kunøe, Nikolaj & Krajci, Peter [Vis alle 8 forfattere av denne artikkelen] (2018). Anxiety, Depression, and Insomnia Among Adults With Opioid Dependence Treated With Extended-Release Naltrexone vs Buprenorphine-Naloxone A Randomized Clinical Trial and Follow-up Study. JAMA psychiatry. ISSN 2168-6238. doi: 10.1001/jamapsychiatry.2018.3537. Fulltekst i vitenarkiv
• Solli, Kristin Klemmetsby; Latif, Zill-E-Huma; Opheim, Arild; Krajci, Peter; Haase, Kamni Sharma & Saltyte Benth, Jurate [Vis alle 8 forfattere av denne artikkelen] (2018). Effectiveness, safety and feasibility of extended-release naltrexone for opioid dependence: a nine-month follow-up to a three-month randomized trial. Addiction. ISSN 0965-2140. 113(10), s. 1840–1849. doi: 10.1111/add.14278.
• Tanum, Lars; Solli, Kristin Klemmetsby; Latif, Zill-E-Huma; Saltyte Benth, Jurate; Opheim, Arild & Haase, Kamni Sharma [Vis alle 8 forfattere av denne artikkelen] (2017). Effectiveness of Injectable Extended-Release Naltrexone vs Daily Buprenorphine-Naloxone for Opioid Dependence. A Randomized Clinical Noninferiority Trial. JAMA psychiatry. ISSN 2168-6238. 74(12), s. 1197–1205. doi: 10.1001/jamapsychiatry.2017.3206.
• Haase, Kamni Sharma; Kunøe, Nikolaj; Opheim, Arild; Gaulen, Zhanna; Njå, Anne-Lill Mjølhus & Zill E, Huma Latif [Vis alle 8 forfattere av denne artikkelen] (2016). Interest in extended release naltrexone among opioid users. European Addiction Research. ISSN 1022-6877. 22(6), s. 301–305. doi: 10.1159/000447964.
• Kunøe, Nikolaj; Opheim, Arild; Solli, Kristin Klemmetsby; Gaulen, Zhanna; Haase, Kamni Sharma & Zill E, Huma Latif [Vis alle 7 forfattere av denne artikkelen] (2016). Design of a randomized controlled trial of extended-release naltrexone versus daily buprenorphine-naloxone for opioid dependence in Norway (NTX-SBX). BMC Pharmacology & Toxicology. ISSN 2050-6511. 17(1). doi: 10.1186/s40360-016-0061-1.
• Bukten, Anne; Lund, Ingunn Olea; Rognli, Eline Borger; Riksheim, Marianne; Lobmaier, Philipp Paul & Skurtveit, Svetlana [Vis alle 8 forfattere av denne artikkelen] (2015). The Norwegian offender mental health and addiction study – Design and implementation of a national survey and prospective cohort study. Substance Abuse: Research and Treatment. ISSN 1178-2218. 9, s. 59–66. doi: 10.4137/SART.S23546. Fulltekst i vitenarkiv
• Kunøe, Nikolaj; Lobmaier, Philipp Paul; Hahn, Ngo & Hulse, Gary (2012). Injectable and implantable sustained release naltrexone in the treatment of opioid addiction. British Journal of Clinical Pharmacology. ISSN 0306-5251. doi: 10.1111/bcp.12011.
• Lobmaier, Philipp Paul; Kunøe, Nikolaj; Gossop, Michael & Waal, Helge (2011). Naltrexone Depot Formulations for Opioid and Alcohol Dependence: A Systematic Review. CNS Neuroscience & Therapeutics. ISSN 1755-5930. 17(6), s. 629–636. doi: 10.1111/j.1755-5949.2010.00194.x.
• Lobmaier, Philipp Paul; Kunøe, Nikolaj; Gossop, Michael & Waal, Helge (2010). Naltrexone Depot Formulations for Opioid and Alcohol Dependence: A Systematic Review. CNS Neuroscience & Therapeutics. ISSN 1755-5930. doi: 10.1111/j.1755-5949.2010.00194.x.
• Kunøe, Nikolaj; Lobmaier, Phillip; Vederhus, John-Kåre; Hjerkinn, Bjørg L; Hegstad, Solfrid & Gossop, Michael [Vis alle 8 forfattere av denne artikkelen] (2010). Retention in naltrexone implant treatment for opioid dependence. Drug and Alcohol Dependence. ISSN 0376-8716. 111(1-2), s. 166–169. doi: 10.1016/j.drugalcdep.2010.03.021.
• Lobmaier, Philipp Paul; Kunøe, Nikolaj; Gossop, Michael; Katevoll, Tormod & Waal, Helge (2010). Naltrexone Implants Compared to Methadone: Outcomes Six Months after Prison Release. European Addiction Research. ISSN 1022-6877. 16(3), s. 139–145. doi: 10.1159/000313336.
• Lobmaier, Philipp Paul; Kunøe, Nikolaj & Waal, Helge (2010). Treatment research in prison: Problems and solutions in a randomized trial. Addiction Research and Theory. ISSN 1606-6359. 18(1), s. 1–13. doi: 10.3109/16066350802531273.
• Kunøe, Nikolaj; Lobmaier, Phillip; John-Kåre, Vederhus; Hjerkinn, Bjørg; Gossop, Michael & Hegstad, Solfrid [Vis alle 8 forfattere av denne artikkelen] (2010). Challenges to antagonist blockade during sustained-release naltrexone treatment. Addiction. ISSN 0965-2140. 105(9), s. 1633–1639. doi: 10.1111/j.1360-0443.2010.03031.x.
• Waal, Helge; Lobmaier, Philipp Paul; Kunøe, Nikolaj; Kornør, Hege & Krook, Aud L (2009). Fire prosjekter i søkelyset? Hva kan vi lære? I Ruyter, Knut W; Solbakk, Jan Helge & Waal, Helge (Red.), Rusmiddelbrukeren og forskeren. Etiske prinsipper, erfaringer og ettertanker. Senter for rus- og avhengighetsforskning og Seksjon for medisinsk etikk. ISSN 978-82-303-1257-5. s. 9–28.
• Kunøe, Nikolaj; Lobmaier, Phillip; Vederhus, John Kåre; Hjerkinn, Bjørg; Hegstad, Solfrid & Gossop, Michael [Vis alle 8 forfattere av denne artikkelen] (2009). Naltrexone implants after in-patient treatment for opioid dependence: randomised controlled trial. British Journal of Psychiatry. ISSN 0007-1250. 194(6), s. 541–546. doi: 10.1192/bjp.bp.108.055319.
• Kunøe, Nikolaj; Lobmaier, Philipp Paul; Vederhus, John Kåre; Hjerkinn, Bjørg; Hegstad, Solfrid & Gossop, Michael [Vis alle 8 forfattere av denne artikkelen] (2009). Naltrexone implants after in-patient treatment for opioid dependence: randomised controlled trial. British Journal of Psychiatry. ISSN 0007-1250. 194, s. 541–546. doi: 10.1192/bjp.bp.108.055319.
• Lobmaier, Philipp Paul; Kornør, Hege; Kunøe, Nikolaj & Bjørndal, Arild (2008). Sustained-release naltrexone for opioid dependence. Cochrane Database of Systematic Reviews. ISSN 1469-493X. doi: 10.1002/14651858.CD006140.pub2. Vis sammendrag

  People with opioid dependence require substantial therapeutic effort to keep them drug free. Their use of illicit opioids can be reduced and retention in treatment improved with supervised agonist replacement therapy with methadone, which is a highly addictive drug. Naltrexone is a long-acting, opioid-antagonist that blocks heroin effects. It is used to prevent relapse of both opioid and alcohol dependence. Highly motivated people do best with naltrexone. Most opioid users are sceptical about treatment with naltrexone tablets and many drop out early on. Dropouts can be reduced with supervised tablet taking, offering incentives and using sustained-release naltrexone such as subcutaneous implants or depot injections. There is insufficient evidence from randomised controlled trials to evaluate the effectiveness of sustained-release naltrexone. In the one controlled study that met inclusion criteria, 60 outpatients were randomised to one of three groups that received two sequential depot injections of naltrexone (192 or 384 mg) or placebo injections. The mean dropout time was 48 days with high dose naltrexone compared with 27 days on placebo; an increase in treatment of 21 days (range 11 to 31 days). The lower depot dose gave a lesser benefit. The number retained in treatment at eight weeks did not show a clear difference and ranged from a mean of 68% to 39% of participants in the different groups. 'Wanting heroin' did not differ on naltrexone but 'needing heroin' scored significantly lower with depot naltrexone compared to placebo. The most prominent adverse effects were general symptoms of fatigue and pain at the injection site. Seventeen reports met inclusion criteria for assessing adverse effects. Seven looked specifically at naltrexone implants for treatment of opioid dependence and wound infection, allergic reaction to the implant and number of implants removed. The majority of the trials did not have a control group and systematic assessment of adverse effects was lacking.

• Hegstad, Solfrid; Khiabani, Hassan Zare; Kristoffersen, Lena; Kunøe, Nikolaj; Lobmaier, Philipp & Christophersen, Asbjørg S. (2008). Drug screening of hair by liquid chromatography-tandem mass spectrometry. Journal of Analytical Toxicology. ISSN 0146-4760. 32(5), s. 364–372.

Se alle arbeider i Cristin

• Kunøe, Nikolaj; Rustad Indregard, Anne Marthe & Nussle, Hans Martin (2024). Open-door policy versus treatment-as-usual in urban psychiatric inpatient wards: a pragmatic, randomised controlled, non-inferiority trial in Norway.
• Kunøe, Nikolaj; Nussle, Hans Martin & Rustad Indregard, Anne Marthe (2022). An RCT of a co-created open-door policy versus usual-treatment in acute psychiatric ward care.
• Rustad Indregard, Anne Marthe; Nussle, Hans Martin & Kunøe, Nikolaj (2022). Using participatory action research to address violence against staff in mental health care.
• Rustad Indregard, Anne Marthe; Nussle, Hans Martin; Vegerstøl, Kristin; Meisingset, Grete & Kunøe, Nikolaj (2022). Psykisk helsevern: Åpen dør-policy er mer enn en ulåst dør. Sykepleien. ISSN 0802-9768.
• Nussle, Hans Martin; Kunøe, Nikolaj; Vegerstøl, Kristin & Lund, Grete Meisingset (2022). Psykisk helsevern: Åpen dør-policy er mer enn en ulåst dør. Tidsskriftet sykepleien. ISSN 0806-7511.
• Jørgenrud, Benedicte Marie; Bogstrand, Stig Tore; Vindenes, Vigdis; Johannessen, Aud; Wüsthoff, Linda Elise & Kunøe, Nikolaj [Vis alle 9 forfattere av denne artikkelen] (2021). Implementering av intervensjon for skadelig alkohol- og legemiddelbruk blant medisinske pasienter .
• Kunøe, Nikolaj (2020). Commentary on Nunes et al. (2020): Blocked opioid use in antagonist treatment—time for cognitive and user‐centered perspectives. Addiction. ISSN 0965-2140. 115(2), s. 247–248. doi: 10.1111/add.14847.
• Kunøe, Nikolaj; Lobmaier, Philipp Paul & Kornør, Hege (2016). Erratum: Removal notice to “Sustained-release naltrexone for opioid dependence: A cochrane review and meta-analysis” (Drug and Alcohol Dependence (2015) 146 (e165–e166)(S037687161401429X)(10.1016/j.drugalcdep.2014.09.367)). Drug and Alcohol Dependence. ISSN 0376-8716. 167, s. 237–237. doi: 10.1016/j.drugalcdep.2016.09.003.
• SANDERUD, LIVE; Tanum, Lars & Kunøe, Nikolaj (2014). L.S. Stavseth og medarbeidere svarer. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 134(2), s. 136–137. doi: 10.4045/tidsskr.13.1669.
• Kunøe, Nikolaj & Lobmaier, Philipp Paul (2011). Twelve-month outcomes of naltrexone implant treatment for opioid dependent outpatients.
• Kunøe, Nikolaj (2011). Langtidsvirkende naltrekson for opiatavhengighet: en Cochraneanalyse.
• Kunøe, Nikolaj (2011). A Cochrane review and meta-analysis of sustained release naltrexone for opioid dependence.
• Kunøe, Nikolaj (2011). Patients receiving opiate substitution have elevated mortality risks at the start and end of treatment. Evidence-Based Mental Health. ISSN 1362-0347. 14(39). doi: 10.1136/ebmh.14.2.39.
• Kunøe, Nikolaj (2010). Flere veier ut av rusavhengigheten - forskerprofil UiO MedFak. [Internett]. http://www.med.uio.no/forskning/aktuelt/profiler/.
• Kunøe, Nikolaj & Randsborg, Sissel (2010). Kapsler som opereres inn under huden og blokkerer effekten av heroin kan bli et nytt behandlingstilbud for heroinmisbrukere. [TV]. TV2 Nyheter.
• Lobmaier, Philipp Paul; Kunøe, Nikolaj & Kornør, Hege (2010). Cochrane review update 2010: Sustained-release naltrexone for opioid dependence. Vis sammendrag

  Naltrexone is an opioid receptor antagonist that blocks the effects of opioids such as heroin and morphine. Naltrexone has no abuse potential, mild and transient side effects and thus appears an ideal pharmacotherapy for opioid dependence. Limited compliance with oral naltrexone treatment is a known drawback. Several naltrexone implant and injectable depot formulations are being investigated and provide naltrexone release for at least one month. During the last couple of years several reports on new formulations have been published. This presentation gives an update on the systematic Cochrane review first published in 2008 on naltrexone injectables and implants for opioid dependence. The new systematic search was conducted in August 2010. To evaluate effectiveness only randomised-controlled trials (RCTs) were included. Reviewers independently evaluated the reports, rated methodological quality and extracted data. When appropriate, meta-analyses were performed for pre-specified outcome measures. The systematic search identified 685 reports as possibly relevant. The findings from the RCTs that were included will be presented at the meeting.

• Waal, Helge; Kunøe, Nikolaj; Lobmaier, Philipp Paul & Christophersen, Asbjørg S (2009). Sustained Release Naltrexone, a promising alternative in treatment of opiate addiction.
• Lobmaier, Philipp Paul; Kunøe, Nikolaj; Gossop, Michael & Waal, Helge (2009). A Randomized Controlled Trial on Naltrexone Implants and Methadone Maintenance Among Heroin Dependent Inmates: Results 6 Months After Prison Release.
• Lobmaier, Philipp Paul; Kunøe, Nikolaj; Gossop, Michael & Waal, Helge (2009). A RANDOMIZED CONTROLLED TRIAL ON NALTREXONE IMPLANTS AND METHADONE MAINTENANCE AMONG HEROIN-DEPENDENT INMATES: RESULTS 6 MONTHS AFTER PRISON RELEASE.
• Willoch, Frode; Lobmaier, Philipp Paul; Kunøe, Nikolaj; Waal, Helge; Andersen, Jannike Mørch & Sundet, Kjetil Søren [Vis alle 7 forfattere av denne artikkelen] (2008). ”Kognitiv evne og nevrobiologiske prosesser hos heroinavhengige i behandling”. Vis sammendrag

  Mange heroinavhengige har nedsatt kognitiv evne og svekket hukommelse. Dette kan relateres til nevrobiologiske effekter av agonisten heroin, som stimulerer opioidreseptorer. Agonistene metadon og buprenorfin brukes som erstatning for heroin i legemiddelassistert rehabilitering (LAR). Det antas at også disse legemidlene påvirker kognitiv evne og hukommelse negativt. Relaterte nevrobiologiske prosesser i LAR-behandling over tid er ikke kartlagt. Naltrekson er en antagonist som blokkerer opioidreseptorer. I implantatform forhindrer naltrekson effektivt tilbakefall til heroinbruk og overdose etter gjennomgått avrusning. Det er uklart hvordan kognitiv evne og hukommelse utvikler seg i langtids naltreksonbehandling. Sammenhengen mellom konsentrasjonen av naltrekson i blod og grad av reseptormetning er ikke undersøkt og har umiddelbar betydning for hvor lenge implantatet virker og for faren for overdoser. Denne prospektive studien skal kartlegge kognitiv evne og nevrobiologiske prosesser blant pasienter i LAR og naltrekson implantatbehandling sammenlignet med pasienter i avholdenhetsorientert behandling og friske kontrollpersoner. Følgende problemstillinger undersøkes: 1. Kognitiv evne hos avholdne heroinavhengige med eller uten naltrekson implantat og relasjon til metning av opioidreseptorer og evt. strukturelle forandringer påvist ved hhv. PET og MR: a. Tidlig i avrusingen? b. Etter 6 måneders avholdenhet? 2. Hvilken effekt har metadon, buprenorfin og naltrekson på kognitiv evne: a. Ved oppstart og etter 6 måneder? b. Forskjeller mellom gruppene? c. Sammenhengen med funn fra hjerneavbildning? 20 pasienter i institusjon og 20 i naltrekson implantatbehandling gjennomgår kognitiv testing og hjerneavbildning med MR og PET etter avrusning. Gruppen i institusjon undersøkes igjen etter 6, gruppen med naltrekson igjen etter 3 og 5 måneder. 20 pasienter på henholdsvis metadon og buprenorfin gjenomgår de samme undersøkelsene ved innleggelse til langtidsbehandling og etter 6 måneder. Alle sammenlignes med friske kontrollpersoner. Prosjektmidler er søkt NFR 2008. Undersøkelsen av friske kontroller og etablering av egnet PET tracer er påbegynt med midler innvilget av NevroNor (NFR).

• Lobmaier, Philipp Paul; Kunøe, Nikolaj & Waal, Helge (2008). Naltrekson implantat som behandling for heroinavhengighet etter løslatelse fra fengsel - resultater etter 6 måneder. Vis sammendrag

  Heroinavhengighet fører ofte til vinningskriminalitet og fengsling. Behandlingstilbudet i fengsel er ikke tilstrekkelig. Tilbakefall til heroin skjer vanligvis raskt etter løslatelse, og faren for å dø av overdose er stor. Fengselsinnsatte har anledning til å søke LAR. For de som har oppnådd avholdenhet under soningen vil ny opiatavhengighet imidlertid ikke alltid være ønskelig. Naltrekson er en opiatantagonist som blokkerer for heroineffekt uten å gi ny avhengighet. Implantatformen har vist seg effektiv i å forebygge tilbakefall til heroin. Denne studien tar sikte på å sammenligne behandlingsverdien av naltrekson implantat med metadon i LAR etter løslatelse fra fengsel. Innsatte fra 5 fengsler ble tilfeldig og fortløpende fordelt til 2 grupper som fikk behandling med: 1. Naltrekson implantat i samarbeid med sosialtjenesten. 2. Metadon etter innvilget LAR søknad. Behandlingen startet før løslatelse og ble evaluert etter 6 måneder. Da sto alle deltakerne fritt til å bytte grupper. 46 innsatte meldte seg frivillig og fylte inklusjonskriteriene. I metadongruppen startet 11 av 22 behandlingen som planlagt. I naltreksongruppen fikk 16 av 24 et implantat før løslatelse. 6 måneder etter løslatelse var kun 5 av 11 fortsatt i LAR og møtte til oppfølging, mens 13 av 16 med implantat møtte. Heroinbruk var signifikant redusert i begge gruppene. Ny kriminalitet og bruk av andre stoffer var redusert, men ble fortsatt hyppig rapportert. Siden gruppene er små bør resultatene tolkes med forsiktighet. Stort frafall i metadongruppen før oppstart gir grunn til bekymring og resultatene tyder på at LAR under soningen bør være lettere tilgjengelig. De som greide å forbli i LAR hadde god nytte av tilbudet. Naltrekson implantat behandlingen førte til signifikant redusert heroinbruk og deltakerne vurderte den som et verdifullt alternativ. Naltrekson implantatbehandling bør derfor evalueres videre i fengselssettingen.

• Lobmaier, Philipp Paul; Kunøe, Nikolaj & Waal, Helge (2008). NALTREXONE IMPLANTS FOR OPIOID DEPENDENCE AMONG PRE-RELEASE INMATES. Vis sammendrag

  Background Opioid dependent individuals contribute substantially to prison populations. Relapse rates and overdose risk after release are high. Heroin-involved offenders represent a subpopulation on the margins among heroin dependants. For heroin-involved offenders, treatment accessibility is limited, and more alternatives should be identified. Naltrexone (NTX) is an opioid-receptor antagonist, blocking the rewarding effects of heroin without inducing dependence. Sustained-release NTX implants provide opioid blockade for 5 to 6 months. This is the first study evaluating NTX implant treatment to prevent heroin relapse after prison release. Methods The study was designed as an open-label, two-arm, randomized-controlled trial, comparing MMT with NTX implant treatment among heroin-involved inmates awaiting release. First follow-up was scheduled at 6 months after release when group crossover was optional. Results The sample comprised 46 poly-drug using inmates of which 27 initiated treatment before release: Eleven of 22 in the MMT group and 16 of 24 in the NTX implant group. Including dropouts, 13 participants from each treatment group met for follow-up after 6 months. Five of 13 were still on methadone. In the NTX group all 13 still had their implant. Ten participants were re-incarcerated, 6 in the NTX and 4 in the MMT group. During the month prior to follow-up, participants in the NTX group used significantly less heroin than participants in the MMT group. Use of other drugs had decreased in both groups compared to baseline. Conclusion Despite high dropout rates in our study, NTX implants were considered a valuable treatment option by heroin-involved offenders and thus warrant further evaluation in prison settings. However, this subpopulation on the margins presents with complex deficiencies in terms of housing, occupation and welfare benefits. Reducing the likelihood of heroin relapse with NTX implants alone is only a first step in the long-term rehabilitation process.

• Hegstad, Solfrid; Khiabani, Hassan; Kunøe, Nikolaj; Kristoffersen, Lena & Christophersen, Asbjørg S. (2007). Håranalyser i forbindelse med kontroll av rusmisbrukere under behandling.
• Lobmaier, Philipp Paul; Kunøe, Nikolaj & Waal, Helge (2006). How to prevent relapse to opioid use after prison release: experiences from an ongoing randomized-controlled trial on naltrexone implants vs. methadone maintenance in custody settings.
• Lobmaier, Philipp Paul; Kunøe, Nikolaj & Waal, Helge (2006). Naltrexone Implants compared to Methadone Maintenance for relapse prevention after prison release: obstacles in addiction research in custody settings. Vis sammendrag

  Opioid dependence is closely related to criminal behaviour with a high prevalence of drug abuse among inmates. While incarcerated, most drug offenders abstain from regular use and are often motivated to begin treatment. Oral naltrexone, when systematically linked to incentives such as working programs or parole, has shown promising results in prison settings; implantable naltrexone may be an effective alternative. This open-label, crossover, randomized controlled trial evaluates the effects of implantable naltrexone for relapse prevention in a sample of opiate dependent inmates, compared to a control group treated with methadone maintenance. Participants are recruited from five prisons in the greater Oslo area. Poly drug users are included, if opioids can be considered the main drug of abuse. Random allocation is completed and medication started while incarcerated. All participants have monthly clinical follow-up meetings with staff from the home community's social services, including a GP. At follow-up 6 (12, 18) months after release, participants complete a EuropASI interview and a hair sample is taken for drug analysis. Study group crossover is optional at any follow-up; the study ends 18 months after prison release. Delinquency and relapse to opioid use are the study's primary outcome measures. Secondary outcome measures are dysphoria, use of other illicit drugs, satisfaction with and quality of life.

• Kunøe, Nikolaj & Lobmaier, Philipp Paul (2005). Blame the counselling, not the implant. A response to Oliver, Horspool & Keen (2005). Addiction. ISSN 0965-2140. 100(7), s. 1027–8.
• Bukten, Anne; Stavseth, Marianne Riksheim; Skurtveit, Svetlana; Kunøe, Nikolaj; Lobmaier, Philipp Paul & Lund, Ingunn Olea [Vis alle 7 forfattere av denne artikkelen] (2016). Rusmiddelbruk og helsesituasjon blant innsatte i norske fengsel. Resultater fra The Norwegian offender mental health and addiction study (NorMA). Universitetet i Oslo. Fulltekst i vitenarkiv
• Kunøe, Nikolaj (2010). Sustained release naltrexone for opioid dependence: Effectiveness, safety and clinical feasibility. Unipub forlag. ISSN 978-82-8072-511-0.
• Kunøe, Nikolaj & Waal, Helge (2010). Sustained release naltrexone for opioid dependence: Effectiveness, safety and clinical feasibility. Unipub forlag. ISSN 978-82-8072-511-0.

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