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. 2025 Jun 6;14(12):4016.
doi: 10.3390/jcm14124016.

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

Angelo G I Maremmani  1   2   3 , Filippo Della Rocca  1   2   4 , Matteo Pacini  1   2 , Silvia Bacciardi  1   2   5 , Silvia Cimino  6 , Luca Cerniglia  7 , Mario Miccoli  2   8 , Icro Maremmani  1   2   3
Affiliations

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

Angelo G I Maremmani et al. J Clin Med. .

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.

Keywords: HUD; OAT; SMO; agonist opioid treatment; alcohol use disorder; efficacy; heroin use disorder; long-term treatment; retention in treatment; safety; sodium oxybate.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study planning. Note: AOT = agonist opioid treatment; HUD = heroin use disorder; AUD = alcohol use disorder; SMO = sodium oxybate.
Figure 2
Figure 2
Alcohol relapsing behavior in AOT responder HUD/AUD patients according to the use of SMO as co-maintenance treatment. Legend: HUD/AUD = heroin use disorder/alcohol use disorder; SMO = sodium oxybate.
See this image and copyright information in PMC

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