Home-based delivery of XR-NTX in youth with opioid addiction

Vo, Hoa T.; Burgower, Rachael; Rozenberg, Ilya; Fishman, Marc

doi:10.1016/j.jsat.2017.08.007

Cited by 16 publications

(25 citation statements)

References 14 publications

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“…Primary outcomes for this study were: (1) number of outpatient XR‐NTX doses received and (2) relapse to opioid use over 24 weeks. Sample size was chosen using a power level of 0.8 and an estimated large effect size based on pilot data with a historical comparison group [42]. Relapse to opioid use was defined as at least 10 days of opioid use within a 4‐week period, using a well‐established and clinically meaningful measure [43,44] that amalgamates self‐report and urine drug screen (UDS) data to calculate days of opioid use.…”

Section: Methodsmentioning

confidence: 99%

“…The youth opioid recovery support (YORS) model includes: home delivery of XR‐NTX, family engagement with an emphasis on promotion of medication adherence, assertive outreach to patients and families and CM for receipt of medication doses. One promising case–series [42] demonstrated the benefit of the YORS model compared to a historical control group who received standard care; however, no randomized study has been conducted. The purpose of this study is to further test the YORS intervention in a pilot randomized controlled trial (RCT).…”

Section: Introductionmentioning

confidence: 99%

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A pilot randomized controlled trial of assertive treatment including family involvement and home delivery of medication for young adults with opioid use disorder

Fishman

Wenzel²,

et al. 2020

Addiction

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Background and Aims Although medications for opioid use disorder (OUD), including extended‐release naltrexone (XR‐NTX), have demonstrated effectiveness, adherence is often low. We tested the preliminary efficacy of youth opioid recovery support (YORS), a multi‐component intervention designed to improve engagement and medication adherence for young adults with OUD. Design Single‐site randomized controlled trial with 24‐week follow‐up. Setting Community substance use disorder treatment program in Baltimore, MD, USA. Participants Young adults aged 18–26 years enrolled in inpatient/residential OUD treatment intending to pursue outpatient OUD treatment with XR‐NTX. Twenty‐one participants were randomized to YORS and 20 to treatment as usual (TAU). The analyzed sample was 65.8% male. Intervention and comparator Components of YORS include: (1) home delivery of XR‐NTX; (2) family engagement; (3) assertive outreach; and (4) contingency management for receipt of XR‐NTX doses. The comparator was TAU, which consisted of a standard referral to outpatient care following an inpatient stay. Measurements Primary outcomes were number of XR‐NTX doses received over 24 weeks and relapse to opioid use (defined as ≥ 10 days of use within 28 days) at 24 weeks. Findings Participants in the YORS condition received more XR‐NTX doses [mean = 4.28; standard deviation (SD) = 2.3] compared with those in TAU (mean = 0.70; SD = 1.2), P < 0.01. Participants in the YORS group compared with TAU had lower rates of relapse (61 versus 95%; P < 0.01). Survival analyses revealed group differences on time to relapse with participants in TAU being more likely to relapse sooner compared with participants in the YORS condition [hazard ratio (HR) = 2.72, 95% confidence interval (CI) = 1.26–5.88, P < 0.01]. Conclusions The youth opioid recovery support intervention for extended‐release naltrexone adherence and opioid relapse prevention among young adults with opioid use disorder appeared to improve treatment and relapse outcomes compared with standard treatment.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A pilot randomized controlled trial of assertive treatment including family involvement and home delivery of medication for young adults with opioid use disorder

Fishman

Wenzel²,

et al. 2020

Addiction

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“…Given only modest efficacy of current psychosocial treatments, pharmacotherapy has been explored as a potential complement to the standard of care [46•]. However, there is limited data regarding the efficacy of pharmacotherapy in treating adolescent SUDs; there are currently no FDA-approved pharmacotherapies for adolescent SUDs other than buprenorphine, which has been indicated down to age 16 for opioid use disorder and has demonstrated efficacy and feasibility among treating opioid-using adolescents [47][48][49][50][51].…”

Section: A Pharmacotherapymentioning

confidence: 99%

Adolescent Substance Use Disorder Treatment: an Update on Evidence-Based Strategies

Fadus

Squeglia

Valadez

et al. 2019

Curr Psychiatry Rep

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Purpose of Review: To examine the most recent published evidence (2016-2019) regarding the treatment of adolescent substance use disorders, and to provide an update on evidence-based strategies, adjunctive interventions, and methods to improve currently established treatment approaches. Recent Findings: Recent evidence suggests that psychosocial treatments such as family-based therapy, cognitive behavioral therapy, and multicomponent approaches remain the most effective methods of treatment; however, innovative ways of improving these treatment strategies may include digital and culturally-based interventions. New advances in adjunctive treatments such as pharmacotherapy, exercise, mindfulness, and recovery-oriented educational centers may have some clinical utility. Summary: Well-established psychosocial interventions remain the primary modality of treatment. Promising new adjunctive treatments and improvements in our currently established treatments may yield significant improvements.

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“…Randomized controlled trials for medication in adolescents with opioid use disorders have only been conducted for buprenorphine/naloxone [48–50]. Research on naltrexone extended release in adolescents has been limited to case series reports [51, 52]. Methadone is very difficult for adolescents to access in the United States, and no recent research exists on the use of this medication in adolescents.…”

Section: Adolescent Opioid Use Disorder Treatmentmentioning

confidence: 99%

“…A descriptive study of sixteen youth, mean age 18.5 years, who received naltrexone extended release showed the majority of the sample (56%) substantially reduced their opioid use or were abstinent from opioids at four-month follow-up [51]. A more recent case series reported on the feasibility of home based administration of naltrexone extended release [52]. Fourteen youth, mean age 20.5 years, who initially receive extended release naltrexone in residential treatment were enrolled in a pilot program offering home-based injections.…”

Section: Adolescent Opioid Use Disorder Treatmentmentioning

confidence: 99%

Opioid Use Disorders in Adolescents—Updates in Assessment and Management

2018

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Purpose of review: To review information specific to adolescents regarding trends in opioid use, risk factors for opioid misuse, medical co-morbidity, and treatment updates. Recent findings: Although opioid misuse in adolescents is uncommon, it is associated with morbidity and mortality such as hepatitis C and overdose. Adolescents commonly start with prescription opioid misuse before transitioning to heroin use. The existing literature supports the use of buprenorphine/naloxone for the treatment of adolescent opioid use disorders. Safe medication storage and disposal is important to decrease adolescent prescription opioid misuse. Summary: Opioid misuse occurs in adolescents and pediatric providers need to remain up to date.

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Home-based delivery of XR-NTX in youth with opioid addiction

Cited by 16 publications

References 14 publications

A pilot randomized controlled trial of assertive treatment including family involvement and home delivery of medication for young adults with opioid use disorder

A pilot randomized controlled trial of assertive treatment including family involvement and home delivery of medication for young adults with opioid use disorder

Adolescent Substance Use Disorder Treatment: an Update on Evidence-Based Strategies

Opioid Use Disorders in Adolescents—Updates in Assessment and Management

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