31 Mar Extended Release Naltrexone Helps Prevent Opioid Relapse in Criminal Justice Offenders

MedicalResearch.com Interview with:

Dr. Joshua Lee

Joshua D. Lee MD, MSc
Associate Professor in Medicine and Psychiatry
NYU Langone Medical Center

MedicalResearch.com: What is the background for this study?

Dr. Lee: Opioid use disorders, both from prescription pain medication and heroin use, and related death rates are increasing annually in the US.  Many states, counties, and cities that have previously not had great experience with heroin addiction are now overwhelmed.  This presents unprecedented challenges to affected families and communities, and also health providers and criminal justice systems that have historically not provided high rates of evidence-based treatment for opioid addictions.  Left untreated or inadequately treated, opioid use disorders are chronic, destructive, and often fatal. Extended-release naltrexone, an opioid receptor blocker, is a promising relapse prevention medication intervention, but had not been evaluated in a US criminal justice system (CJS) setting or under real-world conditions.

This effectiveness study recruited 308 adults with US criminal justice system involvement (i.e., recent jail or prison incarceration, on parole or probation) and a history of opioid dependence (addiction), who were not currently accessing methadone or buprenorphine maintenance treatment, and were interested in treatment with extended-release naltrexone (XR-naltrexone).  All participants were off opioids (detoxed or recently abstinent) at the time of study start (randomization).  Participants randomized to an open-label, non-blinded evaluation of XR-naltrexone versus treatment-as-usual for six months of treatment.  Long-term follow-up occurred at 12 months and 18 months (6 and 12 months post-treatment).  We estimated rates of opioid relapse and opioid use between the two arms over the course of treatment.  We also tracked other drug and alcohol use, re-incarceration rates, and overdose rates throughout the study.

MedicalResearch.com: What are the main findings?

Dr. Lee:Participants assigned to XR-naltrexone completed 77% of scheduled monthly injections; 61% finished all six months of planned treatment.  Relapse rates were higher in the treatment-as-usual group (64%), lower in the XR-naltrexone arm (43%).  There were more days of opioid abstinence, more urine samples negative for any opioids, and fewer overdoses in the XR-naltrexone arm.  Therefore, XR-naltrexone in this large US trial of CJS adults pursuing opioid relapse prevention, was an effective intervention.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Lee:  Providers counseling and treating opioid use disorders should consider XR-naltrexone as an effective relapse prevention strategy in patients not accessing methadone or buprenoprhine maintenance.  XR-naltexone appears to be feasible and well-suited for criminal justice involved clients.   

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Lee:  We now have three excellent medication treatments for opioid use disorders: methadone, buprenorphine, and extended-release naltrexone.  The rates of use of all of these medications should rapidly grow in the face of the US opioid epidemic.  How can we encourage and enable providers and patients to increase their use of these medications?  Once begun, how can we improve and perfect outcomes during medication treatment?  How can we through policy and quality improvement initiatives increase the use of these medications in US jails, prisons, and community-dwelling CJS-involved adults, where they are too little used?

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders

Joshua D. Lee, M.D., Peter D. Friedmann, M.D., M.P.H., Timothy W. Kinlock, Ph.D., Edward V. Nunes, M.D., Tamara Y. Boney, M.S., C.C.R.C., Randall A. Hoskinson, Jr., Donna Wilson, M.S., Ryan McDonald, M.A., John Rotrosen, M.D., Marc N. Gourevitch, M.D., M.P.H., Michael Gordon, D.P.A., Marc Fishman, M.D., Donna T. Chen, M.D., M.P.H., Richard J. Bonnie, L.L.B., James W. Cornish, M.D., Sean M. Murphy, Ph.D., and Charles P. O’Brien, M.D., Ph.D.

N Engl J Med 2016; 374:1232-1242   March 31, 2016

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Dr. Joshua Lee (2016). Extended Release Naltrexone Helps Prevent Opioid Relapse in Criminal Justice Offenders MedicalResearch.com

Last Updated on March 31, 2016 by Marie Benz MD FAAD