The Predictive Value of Degree of Preference for Extended-Release Naltrexone for Treatment Adherence, Opioid Use, and Relapse

Abstract

<b><i>Background:</i></b> Extended-release naltrexone (XR-NTX) is effective for illicit opioid abstinence as an opioid maintenance treatment. To improve treatment outcomes, patient’s preference for the modality of treatment is an important factor. <b><i>Objectives:</i></b> We aimed to test the relationship between baseline preference for XR-NTX and adherence to treatment, use of illicit opioids, and risk of relapse. <b><i>Methods:</i></b> In an open-label, Norwegian clinical trial participants with opioid use disorder were randomized to either monthly injections with XR-NTX or daily sublingual buprenorphine-naloxone (BP-NLX) for 12 weeks. Subsequently, participants could continue with their preferred medication in a 36-week follow-up and in a prolonged period of 104 weeks. <b><i>Results:</i></b> Of 153 participants who completed detoxification, 72% were men, with a mean age of 36 years. Preference levels were similar across the randomized groups, with no significant associations between preference and adherence to treatment, opioid use, or relapse. The BP-NLX group had a significantly higher risk of first relapse to opioids than the XR-NTX group for all levels of preference (<i>p</i> < 0.001) and a significantly higher number of days of illicit opioid use. In the follow-up period, the adherence rate was twice as high among participants with the highest preference compared to participants with the lowest preference, both among those who switched to XR-NTX and those who continued (hazard ratio 2.2; 1.2–4.0, <i>p</i> = 0.013). Opioid use was significantly higher among participants who switched to XR-NTX with the lowest preference than the medium (<i>p</i> = 0.003) or the highest (<i>p</i> = 0.001) preference. The risk of relapse to opioids, however, was significantly higher among XR-NTX continuing participants with the lowest (<i>p</i> = 0.002) or the medium (<i>p</i> = 0.043) preference than those with the highest preference. <b><i>Conclusions:</i></b> Individuals who matched with their preferred treatment used less illicit opioids than those who did not during short-term treatment. However, baseline preference for XR-NTX treatment primarily influenced longer term opioid use and treatment adherence.

Retention in treatment and therapeutic adherence: How are these associated with therapeutic success? An analysis using real‐world data

“…These last two variables have also been shown to be associated with reduced drug use and improvements in patients' quality of life (Lynch et al., 2021 ; Zhou et al., 2017 ). For this reason, various addiction treatment programs have among their objectives the promotion of adherence and retention in treatment (Gaulen et al., 2022 ; Reif et al., 2021 ), with both aspects of the therapeutic process regarded as dependent variables in research on this issue (Bedard‐Gilligan, 2018 ; Daigre et al., 2021 ). Thus, given the use of these two variables in the field of addictions, it is unsurprising that retention and therapeutic adherence have been established as outcomes.…”

Feasibility of Testing Client Preferences for Accessing Injectable Opioid Agonist Treatment (iOAT): A Pilot Study

“…24,30 Healthcare research is increasingly recognizing that client preferences help predict and explain client behaviour 31,32 and that congruency between clients' preferred treatment and administered treatment optimizes care management and improves treatment outcomes. [33][34][35] Research tools that quantitatively capture robust data while remaining relevant to clients might come at the expense of being complex and cumbersome for both researchers and participants. Developed with input from service users, bestworst scaling (BWS) is a quantitative preference elicitation tool where participants select both the best and worst items from a list of at least three levels across multiple choice sets.…”

Risk of Relapse to Non-Opioid Addictive Substances Among Opioid Dependent Patients Treated with an Opioid Receptor Antagonist or a Partial Agonist: A Randomized Clinical Trial

“…An alternative therapeutic approach to maintain opioid abstinence is complete detoxification and induction to antagonist medication ( [4,5,15]; Kristin Klemmetsby [19,22]). Extended-release Naltrexone (XR-NTX) is an opioid antagonist that blocks the euphoric and sedative effects of opioids and offers pharmacological protection against relapse, re-dependence and overdose [1,2,6]. Several studies have confirmed the clinical efficacy of XR-NTX in reducing the use of illicit opioids and with a non-significant increase in the use of addictive non-opioid substances [8,12,16,20,23].…”