Linkage to Primary Care for Persons First Receiving Injectable Naltrexone During Inpatient Opioid Detoxification

Abstract

Introduction Opioid use disorders commonly require ongoing medication-assisted treatment to reduce relapse following discharge from inpatient detoxification programs. Naltrexone, an opioid antagonist, is an increasingly popular treatment option in its once-monthly injectable form (XR-NTX). The aim of this study was to examine the follow-up rates of persons who received an initial injection during inpatient detoxification and scheduled for receipt of a first outpatient injection in the primary care setting. Methods We reviewed the electronic health records of 62 consecutive opioid dependent adults who received an initial injection of XR-NTX during extended inpatient detoxification at Stanley Street Treatment and Resources (SSTAR) in Fall River, Massachusetts, from March 2013 to August 2015, and were referred to the adjacent SSTAR primary care health center for their second injection one month later. Demographic information, drug use and opioid treatment history, and aftercare planning were assessed. Results Participants averaged 32.4 (±7.8) years of age, 90.3% were non-Latino Caucasian, 35.5% were homeless, 21.3% reported a drug overdose in the last year, and 53.2% had been in detoxification within the last year. Of the 62 participants referred to primary care, 34 (54.8%) followed up to receive their second XR-NTX injection. Twenty of these persons received at least a third XR-NTX injection. No demographic, treatment history, substance use behaviors, or aftercare plan variables were associated with receipt of a second injection (p<.20). Conclusion Predicting, and therefore improving, XR-NTX continuation during the transition from inpatient detoxification to primary care may be difficult in this population.

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.…”

“…Seven retrospective studies reported adherence outcomes [22,53,54,[59][60][61][62] (Table 4). Observation periods were generally approximately 6 months long.…”

“…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).…”

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

“…Strategies such as extended‐release medication formulations may help to overcome some of the adherence challenges presented by daily medications. However, even with this advantage, many barriers to retention remain [20,21]. Several studies have examined the impact of extended‐release naltrexone (XR‐NTX) on youth treatment.…”

Effects of incentives for naltrexone adherence on opiate abstinence in heroin‐dependent adults

“…An extended-release injectable suspension of naltrexone (XR-NTX) was developed and is approved for the treatment of opioid use disorder in the United States. XR-NTX appears to improve adherence compared to oral naltrexone [4], but adherence rates are still poor [5][6][7][8][9].…”