Concerns about injectable naltrexone for opioid dependence

Wolfe, Daniel; Carrieri, Patrizia; Dasgupta, Nabarun; Wodak, Alex; Newman, Robert G.; Bruce, R. Douglas

doi:10.1016/s0140-6736(10)62056-9

Cited by 29 publications

(22 citation statements)

References 9 publications

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“…Though preliminary data suggest that opioid antagonists may have some benefit for this population, concerns about cost, uncertainty about release dates and eventual overdose for those not remaining on opioid antagonists (Wolfe et al, 2011) or not transitioning to OST have limited this strategy until more evidence becomes available (Di Paola et al, 2014). Irrespective of whether OST or long-acting opioid antagonist therapies are deployed, both will require organizational change for adoption and expansion where innovations of using medications to treat addiction are counter-intuitive to the CJS (Friedmann et al, 2012; Friedmann et al, 2014; Springer et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Challenges to implementing opioid substitution therapy in Ukrainian prisons: Personnel attitudes toward addiction, treatment, and people with HIV/AIDS

Polonsky

Azbel

Wickersham

et al. 2015

Drug and Alcohol Dependence

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Background Ukraine is experiencing one of the most volatile HIV epidemics globally, fueled primarily by people who inject drugs (PWIDs), and a parallel incarceration epidemic. Opioid substitution therapy (OST) is internationally recognized as one of the most effective forms of treatment for opioid dependence and is among the most effective HIV prevention strategies available, yet efforts to adopt it in Ukraine’s Criminal Justice System (CJS) have been thwarted. Methods To understand the reluctance of the Ukrainian CJS to adopt OST despite the overwhelming evidence pointing to its health benefits and improved criminal justice outcomes, we conducted the first survey of Ukrainian prison administrative, medical and custodial staff (N=243) attitudes towards addiction in general, OST, and people living with HIV/AIDS (PLWHA) in representative regions of Ukraine. Results Results revealed that Ukrainian CJS workers’ attitudes toward OST, PLWHA, and drug addiction were universally negative, but differed substantially along geographic and occupational lines. Whereas geographic and cultural proximity to the European Union drove positive attitudes in the west, in the southern region we observed an identifiability effect, as workers who worked directly with prisoners held the most positive attitudes. We also found that knowledge mediated the effect of drug intolerance on OST attitudes. Conclusion In Ukraine, adoption of OST is more influenced by ideological biases and prejudices than by existing scientific evidence. By elucidating existing attitudes among CJS personnel, this assessment will help direct subsequent interventions to address the barriers to implementing evidence-based HIV prevention treatments.

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Section: Discussionmentioning

confidence: 99%

Challenges to implementing opioid substitution therapy in Ukrainian prisons: Personnel attitudes toward addiction, treatment, and people with HIV/AIDS

Polonsky

Azbel

Wickersham

et al. 2015

Drug and Alcohol Dependence

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“…Though XR-NTX is considered an evidence-based pharmacological treatment for opioid dependence, a 2011 meta-analytic review (91) concluded that evidence to support such strategies for addressing opioid use disorders is currently insufficient. Concerns about cost, uncertainty about release dates, and eventual overdose for those not remaining on opioid antagonists (92) or not transitioning to OAT, have limited this strategy until more evidence becomes available (93). Nonetheless, this strategy is worthy of further pursuit wherever OAT is not available within the CJS.…”

Section: Implications and Future Directionsmentioning

confidence: 99%

Attitudes Toward Addiction, Methadone Treatment, and Recovery Among HIV-Infected Ukrainian Prisoners Who Inject Drugs: Incarceration Effects and Exploration of Mediators

et al. 2016

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In this study, we use data from a survey conducted in Ukraine among 196 HIV-infected people who inject drugs (PWID), to explore attitudes toward drug addiction and methadone maintenance therapy (MMT), and intentions to change drug use during incarceration and after release from prison. Two groups were recruited: Group 1 (n=99) was currently incarcerated and Group 2 (n=97) had been recently released from prison. This paper’s key finding is that MMT treatment and addiction recovery were predominantly viewed as mutually exclusive processes. Group comparisons showed that participants in Group 1 exhibited higher optimism about changing their drug use, were less likely to endorse methadone, and reported higher intention to recover from their addiction. Group 2 participants, however, reported higher rates of HIV stigma. Structural equation modeling revealed that in both groups, optimism about recovery and awareness of addiction mediated the effect of drug addiction severity on intentions to recover.

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“…These assessments specifically address concerns about the potential of overdose deaths after XR-NTX discontinuation and the criticism leveled at the FDA for approving XR-NTX indication without such data. 32,33 Non-fatal self-reported overdose events and deaths are queried using standard AE/SAE forms and reviewed by the NIDA Medical Monitor. Events are coded as drug/alcohol overdose per source documentation (e.g.…”

Section: Research Design and Study Populationmentioning

confidence: 99%

NIDA Clinical Trials Network CTN-0051, Extended-Release Naltrexone vs. Buprenorphine for Opioid Treatment (X:BOT): Study design and rationale

Lee

Nunes

Novo

et al. 2016

Contemporary Clinical Trials

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Introduction For opioid-dependent patients in the US and elsewhere, detoxification and counseling-only aftercare are treatment mainstays. Long-term abstinence is rarely achieved; many patients relapse and overdose after detoxification. Methadone, buprenorphine-naloxone (BUP-NX) and extended-release naltrexone (XR-NTX) can prevent opioid relapse but are underutilized. This study is intended to develop an evidence-base to help patients and providers make informed choices and to foster wider adoption of relapse-prevention pharmacotherapies. Methods The National Institute on Drug Abuse's Clinical Trials Network (CTN) study CTN-0051, X:BOT, is a comparative effectiveness study of treatment for 24 weeks with XR-NTX, an opioid antagonist, versus BUP-NX, a high affinity partial opioid agonist, for opioid dependent patients initiating treatment at 8 short-term residential (detoxification) units and continuing care as outpatients. Up to 600 participants are randomized (1:1) to XR-NTX or BUP-NX. Results The primary outcome is time to opioid relapse (i.e., loss of persistent abstinence) across the 24-week treatment phase. Differences between arms in the distribution of time-to-relapse will be compared (construction of the asymptotic 95% CI for the hazard ratio of the difference between arms). Secondary outcomes include proportions retained in treatment, rates of opioid abstinence, adverse events, cigarette, alcohol, and other drug use, and HIV risk behaviors; opioid cravings, quality of life, cognitive function, genetic moderators, and cost effectiveness. Conclusions XR-NTX and BUP-NX differ considerably in their characteristics and clinical management; no studies to date have compared XR-NTX with buprenorphine maintenance. Study design choices and compromises inherent to a comparative effectiveness trial of distinct treatment regimens are reviewed.

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Concerns about injectable naltrexone for opioid dependence

Cited by 29 publications

References 9 publications

Challenges to implementing opioid substitution therapy in Ukrainian prisons: Personnel attitudes toward addiction, treatment, and people with HIV/AIDS

Challenges to implementing opioid substitution therapy in Ukrainian prisons: Personnel attitudes toward addiction, treatment, and people with HIV/AIDS

Attitudes Toward Addiction, Methadone Treatment, and Recovery Among HIV-Infected Ukrainian Prisoners Who Inject Drugs: Incarceration Effects and Exploration of Mediators

NIDA Clinical Trials Network CTN-0051, Extended-Release Naltrexone vs. Buprenorphine for Opioid Treatment (X:BOT): Study design and rationale

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