A Naturalistic Evaluation of Extended-Release Naltrexone in Clinical Practice in Missouri

J Subst Abuse Treat. 2016 Nov;70:50-57. doi: 10.1016/j.jsat.2016.07.014. Epub 2016 Aug 10.

Abstract

The purpose of this study was to compare the naturalistic outcomes of individuals with alcohol or opioid use problems who were treated with extended-release naltrexone (XR-NTX) to those treated with psychosocial treatment only and also to those treated with other medication-assisted therapies in Missouri during 2010 to 2011. We analyzed intake and discharge data collected as part of SAMHSA's Treatment Episode Data Set assessments. Patients who received XR-NTX during their treatment episode were compared, for those reporting alcohol (but not opioids) as their problem (N=21,137), to those who received oral naltrexone, acamprosate, and psychosocial treatment only, and for those who reported opioids as a problem (N=8996), to those receiving oral naltrexone, buprenorphine/naloxone, and psychosocial treatment only. Group differences were adjusted using propensity score weighting, with propensity scores derived from 18 intake variables. For the alcohol sample, patients who received XR-NTX vs. the oral naltrexone group had superior composite outcomes on a measure combining abstinence, self-help participation, employment, and arrests. For the opioid sample, XR-NTX was found to have significantly better outcomes than oral naltrexone on the composite outcome measure. For both the alcohol and opioid samples, the group that received XR-NTX stayed in treatment longer vs. psychosocial treatment only. In the opioid sample, those receiving buprenorphine/naloxone remained in treatment longer than those receiving XR-NTX.

Keywords: Alcohol; Extended-release naltrexone; Medication-assisted treatment; Opioids; Substance abuse.

MeSH terms

  • Acamprosate
  • Adult
  • Alcohol Deterrents / administration & dosage
  • Alcohol Deterrents / pharmacology*
  • Alcohol-Related Disorders / drug therapy*
  • Delayed-Action Preparations
  • Female
  • Humans
  • Male
  • Middle Aged
  • Missouri
  • Naltrexone / administration & dosage
  • Naltrexone / pharmacology*
  • Narcotic Antagonists / administration & dosage
  • Narcotic Antagonists / pharmacology*
  • Opioid-Related Disorders / drug therapy*
  • Outcome Assessment, Health Care*
  • Psychotherapy / methods*
  • Taurine / administration & dosage
  • Taurine / analogs & derivatives*
  • Taurine / pharmacology

Substances

  • Alcohol Deterrents
  • Delayed-Action Preparations
  • Narcotic Antagonists
  • Taurine
  • Naltrexone
  • Acamprosate