Predictors of induction onto extended-release naltrexone among unemployed heroin-dependent adults

Abstract

Our analyses suggest that individuals recently leaving longer-term opioid detoxification programs are more likely to complete XR-NTX induction. Individuals on parole or probation are less likely to complete XR-NTX induction and may need additional supports or modifications to induction procedures to be successful.

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

“…In both rapid induction protocols, withdrawal was managed with non-opioid medications (e.g., clonidine, trazodone, zolpidem). Another procedure (46, 51) occurred in a specialized outpatient employment-based drug treatment center (52), lasted 1 to 4 weeks, and used a form of contingency management (i.e., employment-based reinforcement). Financial incentives were used to promote opioid abstinence (for participants with recent use) and oral naltrexone adherence.…”

“…Within a sample of opioid users with marijuana use histories, pre-enrollment marijuana use did predict successful induction (45). Finally, in an outpatient contingency management procedure, participants who had recently completed a long-term detox (≥ 21 days) and who were not on parole or probation were more likely to complete the induction than those who completed a shorter-term detox (<21 days) or who were on parole or probation (51). …”

“…In addition, studies should continue to explore patient-level factors that may predict successfully starting XR-NTX. Some behaviors characteristic of less severe opioid use (i.e., using less (54), using primarily prescription opioids (50), being able to complete a long-term detox (51)) may be associated with better outcomes, but these findings need to be replicated.…”

“…Five [28,37,42,47,48] required opioid abstinence at the outset, and one [50] did not require opioid abstinence but recruited recently incarcerated participants who were nearly all abstinent upon release from jail or prison. The nine remaining studies [36,[38][39][40]44,45,49,51,52] included individuals who were actively using opioids and required detoxification. We identified several procedures for detoxifying and inducting individuals on XR-NTX.…”

Development of a Clinically Viable Heroin Vaccine

“…This hypothesis is supported by clinical studies showing that long-acting depot NTX mitigated the reinforcing effects of heroin in humans, 92–93 and instead of heroin users increasing their drug intake to surmount the antagonist, heroin extinction-like behaviors occurred. 91, 94 The obvious major benefits to vaccination over pharmacological antagonists are the potential for increased duration of action and decreased side effects. Co-administration of opioid agonists methadone or buprenorphine as needed along with the vaccine would likely enhance therapeutic efficacy by alleviating opioid cravings.…”