Correlates of retention on extended-release naltrexone among persons living with HIV infection transitioning to the community from the criminal justice system

Abstract

Background The acceptability of and retention on extended-release naltrexone (XR-NTX), an FDA-approved medication for the treatment of alcohol and opioid use disorders, among persons living with HIV disease (PLH) under criminal justice setting (CJS) supervision has not been evaluated to date. Methods Two double-blind placebo-controlled randomized trials of XR-NTX for inmates with HIV disease transitioning to the community with (1) alcohol use disorders (AUDs) or (2) opioid use disorders, are underway. Reasons for not accepting XR-NTX and an evaluation of differences in demographic features between those who were retained on study drug and those who did not return for their second injection post-release are discussed. Results 70% of eligible persons consented to participate; almost 90% received their first injection; and almost 60% returned for their second injection after release. Variables found to be associated (p<0.10) with returning for the second injection included: not meeting criteria for hazardous drinking (p=0.035; OR 0.424 (CI 0.191–0.941)); being prescribed antiretroviral therapy (p=0.068; OR 2.170 (CI 0.943–4.992)); expressing experiencing serious depression 30 days prior to incarceration (p=0.068; OR 1.889 (CI 0.955–3.737)); not having a positive cocaine urine screen on the day of release (DOR) (p=0.011; OR 0.258 (CI 0.091–0.729)); and not meeting criteria for an AUD plus any substance use disorder (p=0.068; OR 0.521 (CI 0.259–1.048)). Only positive cocaine urine test on DOR was statistically significant after multivariate regression analyses (p=0.005; OR 0.207 (CI 0.068–0.623)). Conclusion CJS based XR-NTX programs are highly acceptable among PLH, however retention on XR-NTX after release is negatively impacted by relapse to cocaine use.

Patient preferences and extended-release naltrexone: A new opportunity to treat opioid use disorders in Ukraine

“…Importantly, XR-NTX would provide more options for patients to receive treatment and foster scale-up of evidence-based treatment for opioid use disorders. Findings here differ from PWID in high-income settings like Vancouver where 52% were willing to consider XR-NTX (2015) and similarly high among PWID with co-morbid opioid and alcohol use disorders transitioning from criminal justice settings (Di Paola et al, 2014; Lee et al, 2016; Lee et al, 2015; Springer et al, 2015; Springer et al, 2014). …”

Extended-release naltrexone reduces alcohol consumption among released prisoners with HIV disease as they transition to the community

“…This discrepancy in the availability and utilization of pharmacotherapy for AUDs in this particularly vulnerable group highlights a significant need to implement recommended screening and diagnostic measures and FDA-approved NIAAA-recommended alcohol pharmacotherapies. In addition, as previously reported, this group of PLH with previously unidentified high alcohol severity was highly receptive to pharmacologic treatment with XR-NTX, even in the setting of a double-blinded placebo controlled trial (Springer et al, 2015; Springer et al, 2014), suggesting that if offered, a high acceptance among PLH being released from the CJS would ensue.…”

“…Therefore, evaluating the effect of XR-NTX on alcohol consumption among PLH after being released from incarceration is a major public health priority. Previously, we provided preliminary evidence on the high acceptance of XR-NTX (Springer, 2012; Springer et al, 2014), correlates of retention on XR-NTX one month after release (Krishnan et al, 2015; Springer et al, 2015), as well as the hepatic safety among this population (Vagenas et al, 2014), suggesting it may be effectively implemented within the CJS. Key findings from this study are the lack of difference in alcohol consumption using Bayesian modeling, yet a number of new findings did emerge.…”

“…The study protocol and methods have previously been described extensively (Springer et al, 2014), along with preliminary safety (Vagenas et al, 2014) and early post-release retention data (Springer et al, 2015). Briefly, Project INSPIRE is a prospective, double-blinded randomized, placebo-controlled trial of XR-NTX among incarcerated PLH with AUDs who were transitioning to the community from September 2010 and February 2015.…”

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

“…Criminal justice offenders treated with XR‐NTX had double the median length of opioid‐free time compared with those who received brief counseling and a referral to community treatment 71. Positive outcomes extended to offenders with multiple diagnoses, including HIV116 and drug court‐involved persons 117…”