Baseline characteristics of patients predicting suitability for rapid naltrexone induction

Abstract

Background and Objectives Extended-release (XR) injection naltrexone has proved promising in the treatment of opioid dependence. Induction onto naltrexone is often accomplished with a procedure known as rapid naltrexone induction. The purpose of this study was to evaluate pre-treatment patient characteristics as predictors of successful completion of a rapid naltrexone induction procedure prior to XR naltrexone treatment. Methods A chart review of 150 consecutive research participants (N = 84 completers and N = 66 non-completers) undergoing a rapid naltrexone induction with the buprenorphone-clonidine procedure were compared on a number of baseline demographic, clinical and psychosocial factors. Logistic regression was used to identify client characteristics that may predict successful initiation of naltrexone after a rapid induction-detoxification. Results Patients who failed to successfully initiate naltrexone were younger (AOR: 1.040, CI: 1.006, 1.075), and using 10 or more bags of heroin (or equivalent) per day (AOR: 0.881, CI: 0.820, 0.946). Drug use other than opioids was also predictive of failure to initiate naltrexone in simple bivariate analyses, but was no longer significant when controlling for age and opioid use level. Conclusions Younger age, and indicators of greater substance dependence severity (more current opioid use, other substance use) predict difficulty completing a rapid naltrexone induction procedure. Such patients might require a longer period of stabilization and/or more gradual detoxification prior to initiating naltrexone. Scientific Significance Our study findings identify specific characteristics of patients who responded positively to rapid naltrexone induction.

Extended‐release injectable naltrexone for opioid use disorder: a systematic review

“…Four studies (42, 45, 46, 50) experimentally investigated whether adjunctive medication, detox-type, or induction contingencies and setting impacted XR-NTX induction, and four studies (45, 50, 51, 54) examined baseline predictors of XR-NTX induction. Adding dronabinol (a cannabinoid-1 partial agonist) to an 8-day inpatient rapid detox did not significantly improve induction rates compared to placebo (66% vs. 55%).…”

Long-Acting Injectable Naltrexone Induction: A Randomized Trial of Outpatient Opioid Detoxification With Naltrexone Versus Buprenorphine

“…12, 32,33 Higher success rates for naltrexone induction were seen in participants with primary prescription opioid abuse, typically reflecting a lower level of physical dependence. For heroin-using individuals with higher-severity opioid dependence, further work is needed to make rapid induction more feasible.…”

“…Participants were stratified by severity of opioid dependence: low-use stratum: ≤5 bags per day or ≤200 mg of morphine equivalents, and high-use stratum: >5 bags per day or >200 mg of morphine equivalents because baseline severity has predicted successful naltrexone induction in previous studies. 21,32 Within each stratum participants were randomized 2:1 to naltrexone detoxification (n=98) or buprenorphine detoxification (n=52) to afford increased opportunity to examine safety and efficacy of the naltrexone-assisted regimen.…”

“…14,16,20–25,32 On Day 3, participants began standing doses of clonidine (0.1–0.2 mg every 4 hours up to 1.2 mg) and clonazepam (1.0 mg every 6 hours up to 2 mg), which continued until Day 8. On Day 4, following pretreatment with prochlorperazine 10 mg, oral naltrexone was started at a dose of 1 mg, with additional doses given daily in ascending order (3 mg, 6 mg, 12 mg, 25 mg).…”

Ethical and clinical safety considerations in the design of an effectiveness trial: A comparison of buprenorphine versus naltrexone treatment for opioid dependence

“…Inpatient treatment is the most reliable way to get a patient through this “induction hurdle”. Even so, a certain proportion of patients, 30% or more based on prior experience, dropout from inpatient before starting XR-NTX, likely subsequently relapsing [36]. …”