Use of Disulfiram for Alcohol Relapse Prevention in Patients in Opioid Maintenance Treatment

Objectives: The aim of this study was to assess the effectiveness, tolerability, and safety of alcohol relapse prevention with disulfiram in alcohol-dependent patients in opioid maintenance treatment under routine treatment conditions. Methods: Twenty-nine opioid maintenance treatment patients were observed from the beginning of outpatient disulfiram treatment for up to 6 months. Patients received disulfiram (mostly 300 mg/d) together with their daily opioid dose. Patients were assessed through urine screens for alcohol (ethyl gluconoride) and other drugs at least twice monthly; blood chemistry analyses after 1, 3, and 6 months; and clinical interviews after 3 and 6 months. Results: Most patients presented with somatic and/or psychiatric comorbidity and/or polydrug use at baseline. Half of the patients completed 6 months of disulfiram treatment. Alcohol use was low during disulfiram treatment. Levels of other drug use did not change. For most patients, 1 or more adverse events were reported, often mild and/or short lived. Three patients experienced severe adverse events attributable to disulfiram. Conclusions: Disulfiram is a viable treatment option for the high-risk population studied here. A close monitoring of side effects and adverse events is necessary, in particular, in patients with polysubstance use.