Adoption of Injectable Naltrexone in U.S. Substance Use Disorder Treatment Programs

Abstract

ABSTRACT. Objective: Medication-assisted treatment for substance use disorders (SUDs) is not widely used in treatment programs. The aims of the current study were to document the prevalence of adoption and implementation of extended-release injectable naltrexone, the newest U.S. Food and Drug Administration-approved medication for alcohol use disorder (AUD), in U.S. treatment programs and to examine associations between organizational and patient characteristics and adoption. Method: The study used interview data from a nationally representative sample of 307 U.S. SUD treatment programs to examine adoption and implementation of injectable naltrexone. Results: Thirteen percent of programs used injectable naltrexone for AUD, and 3% of programs used it for opioid use disorder. Every treatment program that offered injectable naltrexone to its patients used it in conjunction with psychosocial treatment, particularly cognitive behavioral therapy. Multivariate logistic regression results indicated that adoption was positively associated with the provision of wraparound services, the percentage of privately insured patients, and the presence of inpatient detoxifi cation services. For-profi t status and offering inpatient services were negatively associated with adoption. Within adopting programs, an average of 4.1% of AUD patients and 7.1% of patients with opioid use disorder were currently receiving the medication, despite clinical directors' reports of positive patient outcomes, particularly for relapsers and for those who had been noncompliant with other medications. Cost was a signifi cant issue for the majority of adopting organizations. Conclusions: The rate of adoption of injectable naltrexone in U.S. treatment programs remains limited. Researchers should continue to examine patient, organizational, and external characteristics associated with the adoption and implementation of injectable naltrexone over time. (J. Stud. Alcohol Drugs, 76, 143-151, 2015)

Treatment strategy profiles in substance use disorder treatment programs: A latent class analysis

“…Finally, centers with greater reliance on insured clients were more likely to offer diverse treatments, making them more competitive in their operational environment. Other research has also found an association between reliance on competitive revenue and EBP adoption (Aletraris et al, 2015; Knudsen et al, 2006, 2007). …”

“…Similarly, structural resources, like access to prescribing staff and infrastructural supports for coordinated care found in larger, older, and hospital-based programs, have been demonstrated to facilitate innovation (Abraham et al, 2010; Knudsen et al, 2007; Roman and Johnson, 2002). Finally, center reliance on competitive funding may increase pressure to provide a wide-range of treatments as is the case with entrepreneurial centers dependent on private funds, clients with insurance, or with for-profit status (Aletraris et al, 2015; Knudsen et al, 2006; 2007). …”

Evidence on the Effectiveness of Heroin-Assisted Treatment

“…However, initiation of naltrexone requires full detoxification from opioids (typically seven to ten days of abstinence from opioids), including from methadone and buprenorphine. Combined with the relatively higher costs of naltrexone, the requirement to be opioid-free prior to induction may limit its feasibility for many individuals (Aletraris et al, 2015;Lee et al, 2018).…”

A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder 

“…The majority of such studies have focused on oral buprenorphine, nding salient barriers to include a lack of training for physicians in MOUD and addiction treatment, concerns about diversion, insurance barriers, and discomfort in treating patients with comorbid psychiatric conditions (15,(24)(25)(26)(27)(28). Fewer studies have examined extended-release naltrexone; current research suggests that insurance-related factors, the requirement that patients are completely opioid-abstinent for 7 to 10 days prior to initiation, inadequate sta ng, and limited education for prescribing physicians are key barriers to prescribing extendedrelease naltrexone (10,(29)(30)(31)(32). Even though methadone for OUD cannot be prescribed outside of OTPs, o ce-based physicians can refer patients to these facilities for methadone treatment; but little is known about frequency of and barriers to this referral process.…”