# Sodium Oxybate (SMO) as Part of Agonist Opioid Treatment in Alcohol–Heroin-Addicted Patients

## TL;DR

This study shows that combining methadone and sodium oxybate helps treat alcohol and heroin addiction more effectively than stopping sodium oxybate after detox.

## Contribution

The study introduces sodium oxybate as a viable long-term adjunct to methadone in treating co-occurring alcohol and heroin addiction.

## Key findings

- Patients maintained on SMO had higher treatment retention rates.
- Discontinuing SMO after detox was linked to higher dropout rates.
- Long-term SMO use improved outcomes and reduced severity of illness.

## Abstract

Background: Alcohol use disorder in the context of heroin addiction presents a significant challenge for clinicians, particularly in selecting the most appropriate pharmacological treatment. Methods: The present study aimed to retrospectively evaluate the efficacy of a six-month methadone maintenance (MM)/sodium oxybate (SMO) combination treatment in reducing ethanol intake among chronic alcohol-dependent patients with heroin use disorder (HUD). Specifically, we compared outcomes between those who continued SMO treatment after alcohol detoxification (MM/SMO-Maintained) and those who discontinued it (MM/SMO-Detoxified). Data were recruited using the ‘Pisa Addiction Database’ through a retrospective, naturalistic, cross-sectional comparative design involving a single patient assessment. Results: Our results indicate that treatment retention was higher in the MM/SMO-Maintained group. Conversely, discontinuing SMO treatment after alcohol detoxification was associated with a higher likelihood of dropout. At the endpoint, the MM/SMO-Maintained group showed significant improvement and was considered less severely ill. Conclusions: Long-term SMO treatment has proven to be well tolerated and effective in preventing relapse in individuals with both alcohol and HUD undergoing agonist opioid treatment. SMO may be considered the closest pharmacological option to substitution therapy for alcohol use disorder, and ongoing agonist opioid treatment should not preclude its co-administration.