Extended-released naltrexone (XR-NTX) is a Food and Drug Administration (FDA)-approved medication associated with higher rates of abstinence, reduced cravings, and delayed relapse to use. However, there is a dearth of literature on real-world implementation of XR-NTX. The Los Angeles County Department of Public Health, in collaboration with UCLA Integrated Substance Abuse Programs, developed a demonstration project to inc'rease access to XR-NTX. This article describes that project, along with data on the expansion of XR-NTX service delivery and patient uptake.
Methods
A secondary descriptive data analysis of demographics, substance use history, current substance use behaviors, health-related variables, and dosing records was conducted on 609 patients who received XR-NTX from Los Angeles County substance use disorder (SUD) treatment facilities from April 2010 through July 2013. A geographic information system approach mapped the distribution of XR-NTX–referring agencies across Los Angeles County.
Results
Of the 609 records analyzed, a majority of patients (64%) obtained more than 1 dose of XR-NTX. Most XR-NTX patients reported alcohol use disorder (71.9%; n = 438). Compared with the general Los Angeles County substance use disorder patients, XR-NTX recipients reported more severe substance use histories. Finally, XR-NTX was accessed by providers in 6 of the 8 Service Planning Areas of Los Angeles County.
Conclusions
These findings reflect a higher XR-NTX cessation rate and a lower average number of doses, in contrast to similar demonstration projects in community settings with patients on parole or probation. However, this study shows that it is feasible to engage treatment providers in the use XR-NTX among their patients with alcohol or opioid use disorders. Several implications for future research and implementation are discussed.
National Quality Forum (NQF). National voluntary consensus standards for the treatment of substance use conditions: evidence-based treatment practices. Paper presented at The National Quality Forum; 2007; Washington, DC.
2.
World Health Organization. Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. Geneva, Switzerland: World Health Organization; 2009.
3.
JohanssonBA, BerglundM, LindgrenA. Efficacy of maintenance treatment with naltrexone for opioid dependence: a meta-analytical review. Addiction. 2006;101:491–503.
KovasAE, McFarlandBH, McCartyDJ, BovermanJF, ThayerJA. Buprenorphine for acute heroin detoxification: diffusion of research into practice. J Subst Abuse Treat. 2007;32:199–206.
6.
KranzlerHR, StephensonJJ, MontejanoL, WangS, GastfriendDR. Persistence with oral naltrexone for alcohol treatment: implications for health-care utilization. Addiction. 2008;103:1801–1808.
7.
VolkowND, FriedenTR, HydePS, ChaSS. Medication-assisted therapies–tackling the opioid-overdose epidemic. N Engl J Med. 2014;370:2063–2066.
8.
KnudsenHK, AbrahamAJ, RomanPM. Adoption and implementation of medications in addiction treatment programs. J Addict Med. 2011;5:21–27.
9.
KnudsenHK, DucharmeLJ, RomanPM. Early adoption of buprenorphine in substance abuse treatment centers: data from the private and public sectors. J Subst Abuse Treat. 2006;30:363–373.
10.
KnudsenHK, DucharmeLJ, RomanPM. The use of antidepressant medications in substance abuse treatment: the public-private distinction, organizational compatibility, and the environment. J Health Soc Behav. 2007;48:195–210.
11.
RieckmannT, KovasAE, RutkowskiBA. Adoption of medications in substance abuse treatment: priorities and strategies of single state authorities. J Psychoactive Drugs. 2010;(Suppl 6):227–238.
12.
Substance Abuse and Mental Health Services Administration. National Survey of Substance Abuse Treatment Services (N-SSATS): 2010. Data on Substance Abuse Treatment Facilities. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2011.
13.
AbrahamAJ, KnudsenHK, RieckmannT, RomanPM. Disparities in access to physicians and medications for the treatment of substance use disorders between publicly and privately funded treatment programs in the United States. J Stud Alcohol Drugs. 2013;74:258–265.
14.
RomanPM, AbrahamAJ, KnudsenHK. Using medication-assisted treatment for substance use disorders: evidence of barriers and facilitators of implementation. Addict Behav. 2011;36:584–589.
15.
Van den BrinkW, HaasenC. Evidenced-based treatment of opioid-dependent patients. Can J Psychiatry. 2006;51:635–646.
16.
AbrahamAJ, RomanPM. Early adoption of injectable naltrexone for alcohol-use disorders: findings in the private-treatment sector. J Stud Alcohol Drugs. 2010;71:460–466.
17.
Center for Substance Abuse Treatment. Incorporating Alcohol Pharmacotherapies Into Medical Practice. Treatment Improvement Protocol (TIP) Series 49. In: Treatment CfSA, ed. Rockville, MD: xxx; 2009.
18.
ThomasCP, GarnickDW, HorganCM, . Advancing performance measures for use of medications in substance abuse treatment. J Subst Abuse Treat. 2011;40:35–43.
19.
KnudsenHK, AbrahamAJ, OserCB. Barriers to the implementation of medication-assisted treatment for substance use disorders: the importance of funding policies and medical infrastructure. Eval Program Plann. 2011;34:375–381.
20.
AbrahamAJ, RieckmannT, McNultyT, KovasAE, RomanPM. Counselor attitudes toward the use of naltrexone in substance abuse treatment: a multi-level modeling approach. Addict Behav. 2011;36:576–583.
21.
RieckmannTR, KovasAE, McFarlandBH, AbrahamAJ. A multi-level analysis of counselor attitudes toward the use of buprenorphine in substance abuse treatment. J Subst Abuse Treat. 2011;41:374–385.
22.
PintoRM, YuG, SpectorAY, GorroochurnP, McCartyD. Substance abuse treatment providers’ involvement in research is associated with willingness to use findings in practice. J Subst Abuse Treat. 2010;39:188–194.
ComerSD, SullivanMA, YuE, . Injectable, sustained-release naltrexone for the treatment of opioid dependence: a randomized, placebo-controlled trial. Arch Gen Psychiatry. 2006;63:210–218.
25.
PettinatiHM, RabinowitzAR. Choosing the right medication for the treatment of alcoholism. Curr Psychiatry Rep. 2006;8:383–388.
26.
CirauloDA, DongQ, SilvermanBL, GastfriendDR, PettinatiHM. Early treatment response in alcohol dependence with extended-release naltrexone. J Clin Psychiatry. 2008;69:190–195.
27.
GarbuttJC, KranzlerHR, O'MalleySS, . Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA. 2005;293:1617–1625.
28.
LeeJD, GrossmanE, DiRoccoD, . Extended-release naltrexone for treatment of alcohol dependence in primary care. J Subst Abuse Treat. 2010;39:14–21.
29.
PettinatiHM, OslinDW, KampmanKM, . A double-blind, placebo-controlled trial combining sertraline and naltrexone for treating co-occurring depression and alcohol dependence. Am J Psychiatry. 2010;167:668–675.
MannelliP, PeindlK, MasandPS, PatkarAA. Long-acting injectable naltrexone for the treatment of alcohol dependence. Expert Rev Neurother. 2007;7:1265–1277.
32.
PettinatiHM, GastfriendDR, DongQ, KranzlerHR, O'MalleySS. Effect of extended-release naltrexone (XR-NTX) on quality of life in alcohol-dependent patients. Alcohol Clin Exp Res. 2009;33:350–356.
33.
O'MalleySS, GarbuttJC, GastfriendDR, DongQ, KranzlerHR. Efficacy of extended-release naltrexone in alcohol-dependent patients who are abstinent before treatment. J Clin Psychopharmacol. 2007;27:507–512.
34.
LukasSE, LowenSB, LindseyKP, . Extended-release naltrexone (XR-NTX) attenuates brain responses to alcohol cues in alcohol-dependent volunteers: a bold FMRI study. NeuroImage. 2013;78:176–185.
35.
KrupitskyE, NunesEV, LingW, GastfriendDR, MemisogluA, SilvermanBL. Injectable extended-release naltrexone (XR-NTX) for opioid dependence: long-term safety and effectiveness. Addiction. 2013;108:1628–1637.
36.
SullivanMA, BisagaA, MarianiJJ, . Naltrexone treatment for opioid dependence: does its effectiveness depend on testing the blockade?Drug Alcohol Depend. 2013;133:80–85.
37.
PettinatiHM, VolpicelliJR, PierceJDJr, O'BrienCP. Improving naltrexone response: an intervention for medical practitioners to enhance medication compliance in alcohol dependent patients. J Addict Dis. 2000;19:71–83.
38.
Crevecoeur-MacPhailD, RansomL, MyersAC, . Inside the black box: measuring addiction treatment services and their relation to outcomes. J Psychoactive Drugs. 2010;42(Suppl 6):269–276.
39.
CovielloDM, CornishJW, LynchKG, . A multisite pilot study of extended-release injectable naltrexone treatment for previously opioid-dependent parolees and probationers. Subst Abus. 2012;33:48–59.
40.
CollinsSE, DuncanMH, SmartBF, . Extended-release naltrexone and harm reduction counseling for chronically homeless people with alcohol dependence. Subst Abus. 2015; 2:36(1):21–33
41.
Substance Abuse and Mental Health Services Administration. 2011State Profile — California National Survey of Substance Abuse Treatment Services (N-SSATS). Substance Abuse and Mental Health Services Administration; 2011.
42.
CaponeT, BrahenL, CondrenR, KordalN, MelchiondaR, PetersonM. Retention and outcome in a narcotic antagonist treatment program. J Clin Psychol. 1986;42:825–833.
43.
GreensteinRA, EvansBD, McLellanAT, O'BrienCP. Predictors of favorable outcome following naltrexone treatment. Drug Alcohol Depend. 1983;12:173–180.
