Исследование эффективности и механизма действия блокатора опийных рецепторов вивитрола в условиях наркологического диспансера

Представлены литературные данные о роли опиоидной и дофаминергической систем головного мозга в формировании алкогольной зависимости. Проанализированы долгосрочные результаты применения блокатора опийных рецепторов пролонгированного действия - налтрексона (Вивитрола) при лечении алкогольной и наркотической зависимостей в условиях наркологического диспансера. На основании полученных результатов предпринята попытка оценить целесообразность внедрения концепции применения препаратов из группы блокаторов опиоидных рецепторов в условиях наркологических диспансеров с учетом клинических и социальных характеристик больных, состоящих на диспансерном учете.

Study of the efficacy and mechanism of action of the blocker with opioid receptors of vivitrol in conditions of narcological dispensry

In recent years,the budgetary program of drug’s use from the group blockers of opium receptors - an injection of long-acting naltrexone (Vivitrol) is big presented in public narcological clinics. The major target of exposure is reducing the euphoric and reinforcing actions of ethanol. This effect is possible because of the blockade of μ-opioid receptors, as a result reducing the euphoric effect of alcohol and there is a reduction of pathological addiction to alcohol. The aim of this research is to study the efficacy of Vivitrol in patients of the narcological clinic, who represent a homogenous group and are characterized by duration of disease, concomitant physical illness, low educational level, persistent reduction of social and labour adaptation and personality changes. In the article were analyzed the results of the use of Vivitrol on the basis ofFederal state budgetary health institution “MNPC Drug Abuse Treatment”,branch office№2. 50 patients were examinedin 2014-2016. (31 - with alcohol dependence 19 - drug dependence) - 34 men and 16 women aged 30 to 65 years. The average age was 44 years, average disease duration - 16 years. Patients were prescribed in a dose of Vivitrol 380 mg\m once a month. According to the instruction it was conducted a course of 6 injections to patients with alcohol dependence and 12 injections to patients with drug dependence. In case of failure of remission,the drug administration was stopped and the patient was sent to the narcological clinic. Remission 1 year was formed only in 14 patients (28%) out of 50. The results of the study allow us to conclude that patients perceive the treatment as prohibitive. Sober attitude was formed on the background of suggestive method. The main value of the method, according to foreign studies, is that the patient can phase out gradually. In this case, by reducing the therapy euphoric component of the structure intoxication, the patient is a gradual "depreciation" of intoxication and has seen a steady attenuation of alcoholic dominant.Consequently, the main goal of therapy of the blocker with opioid receptors - decrease in dose of consumed alcohol.This strategy is not possible in conditions of narcological clinic, because the dispensary observation in the Russian Federation provides of the patient for the removal with respect for absolute sobriety more than 3 years. The use of Vivitrol in alcoholic patients justified as a restraining procedure, and its effect is mainly due to the form of psychotherapy.