Gender differences in treatment and clinical characteristics among patients receiving extended release naltrexone

Abstract

Further research is needed to investigate real-world acceptability of extended-release naltrexone for alcohol and opioid use disorders, and potential gender differences. This study examines treatment and clinical characteristics among men and women receiving extended-release naltrexone in a large, publicly funded substance use disorder treatment system (N = 465; 52% female). Patient demographics, treatment characteristics, and the number of extended-release naltrexone doses received were collected from administrative data and treatment program staff. Additionally, patients provided information on experiences with extended-release naltrexone in an open-ended format at 1, 2, and 3 weeks following their first injection. For a subsample of patients (N = 220), alcohol/opioid cravings and specific adverse effects were also assessed. Compared to men, women reported experiencing a higher rate and mean number of adverse effects. Overall, craving scores showed substantial reductions over time. However, among patients taking extended-release naltrexone for alcohol use, women showed a significantly greater reduction in craving scores compared to men. No gender differences were observed in the number of extended-release naltrexone doses received. Although women may have a greater need for additional support in managing early adverse effects, extended-release naltrexone as an adjunct to psychosocial treatment may be an acceptable and promising treatment approach for both men and women, and particularly for women prescribed extended-release naltrexone for alcohol use. This study contributes further information on patients' experiences during the early course of extended-release naltrexone treatment in real-world settings. Understanding these experiences may assist policy makers and treatment providers in addressing challenges of implementing this treatment into wider practice.

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

“…Eight studies (44, 45, 48, 50, 55, 60, 61, 64) reported whether a variety of participant factors (e.g., demographics, drug use) were associated with XR-NTX adherence (Supplemental Table 2). Some variables were related to adherence but many of the associations were inconsistent across studies or reported only by one study.…”

“…f Sample overlaps with that used in [54]. Only outcomes not reported in that study are reported for [57]. g Variable but included patient's residential stay (< 1 month) through follow-up, which occurred ≤ 10 days post-discharge.…”

“…Finally, incarcerated participants who initiated XR-NTX prior to release had higher adherence than those who were referred to XR-NTX treatment in the community, although this effect disappeared over time [42]. Eight studies [38,39,43,51,52,54,57,60] reported whether a variety of participant factors (e.g. demographics, drug use) were associated with XR-NTX adherence (Supporting information, Table 2).…”

Effectiveness, safety and feasibility of extended‐release naltrexone for opioid dependence: a 9‐month follow‐up to a 3‐month randomized trial

“…Naltrexone is an opioid antagonist that competitively blocks euphoric effects of heroin and other opioids, thereby preventing relapse of opioid abuse and overdose deaths when used as prescribed . It also reduces the craving for opioids and alcohol .…”

The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder

“…Potential gastrointestinal side effects of naltrexone may occur more often among women than men (Herbeck et al 2016) and include abdominal pain (11% vs. 8% in placebo), diarrhea (13% vs. 10% in placebo), nausea (29% vs. 11% in placebo), and vomiting (12% vs. 6% in placebo; Micromedex 2017c). Dizziness also appears to be more frequent with naltrexone (13% vs. 4% in placebo; Micromedex 2017c).…”