Regular article
A Naturalistic Evaluation of Extended-Release Naltrexone in Clinical Practice in Missouri

https://doi.org/10.1016/j.jsat.2016.07.014Get rights and content

Highlights

  • Naturalistic outcomes and durations of treatment episodes for individuals with alcohol or opioid use problems who were treated with extended-release naltrexone (XR-NTX) were compared to those treated with psychosocial treatment only and also to other medication-assisted therapies in Missouri during 2010 to 2011.

  • Group differences were controlled statistically using propensity scores that were based on 18 intake variables.

  • Patients with alcohol use problems and also those with opioid problems receiving XR-NTX in real-world clinical settings remained in treatment longer than those receiving psychosocial treatment only.

  • For both alcohol and opioid samples, patients who received XR-NTX had superior outcomes compared to those who receive oral naltrexone on a measure combining abstinence, self-help participation, employment, and arrests. The XR-NTX-treated group also has greater improvement on the composite outcome compared to buprenorphine/naloxone is the opioid sample.

  • These hypothesis-generating findings deserve further study in randomized clinical trials.

Abstract

The purpose of this study was to compare the naturalistic outcomes of individuals with alcohol or opioid use problems who were treated with extended-release naltrexone (XR-NTX) to those treated with psychosocial treatment only and also to those treated with other medication-assisted therapies in Missouri during 2010 to 2011. We analyzed intake and discharge data collected as part of SAMHSA's Treatment Episode Data Set assessments. Patients who received XR-NTX during their treatment episode were compared, for those reporting alcohol (but not opioids) as their problem (N = 21,137), to those who received oral naltrexone, acamprosate, and psychosocial treatment only, and for those who reported opioids as a problem (N = 8996), to those receiving oral naltrexone, buprenorphine/naloxone, and psychosocial treatment only. Group differences were adjusted using propensity score weighting, with propensity scores derived from 18 intake variables. For the alcohol sample, patients who received XR-NTX vs. the oral naltrexone group had superior composite outcomes on a measure combining abstinence, self-help participation, employment, and arrests. For the opioid sample, XR-NTX was found to have significantly better outcomes than oral naltrexone on the composite outcome measure. For both the alcohol and opioid samples, the group that received XR-NTX stayed in treatment longer vs. psychosocial treatment only. In the opioid sample, those receiving buprenorphine/naloxone remained in treatment longer than those receiving XR-NTX.

Keywords

Substance abuse
Extended-release naltrexone
Medication-assisted treatment
Opioids
Alcohol

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