title: Employment-based reinforcement of adherence to depot naltrexone in unemployed opioid-dependent adults: a randomized controlled trial.
abstract: OBJECTIVE
  Naltrexone can be used to treat opioid dependence, but patients refuse to take it. Extended-release depot formulations may improve adherence, but long-term adherence rates to depot naltrexone are not known. This study determined long-term rates of adherence to depot naltrexone and whether employment-based reinforcement can improve adherence.
  
  
  METHODS
  Participants who were inducted onto oral naltrexone were assigned randomly to contingency (n = 18) or prescription (n = 17) groups. Participants were offered six depot naltrexone injections and invited to work at the therapeutic workplace on week days for 26 weeks, where they earned stipends for participating in job skills training. Contingency participants were required to accept naltrexone injections to maintain workplace access and to maintain maximum pay. Prescription participants could work independently of whether they accepted injections.
  
  
  METHODS
  The therapeutic workplace, a model employment-based intervention for drug addiction and unemployment.
  
  
  METHODS
  Opioid-dependent unemployed adults.
  
  
  METHODS
  Depot naltrexone injections accepted and opiate-negative urine samples.
  
  
  RESULTS
  Contingency participants accepted significantly more naltrexone injections than prescription participants (81% versus 42%), and were more likely to accept all injections (66% versus 35%). At monthly assessments (with missing urine samples imputed as positive), the groups provided similar percentages of samples negative for opiates (74% versus 62%) and for cocaine (56% versus 54%). Opiate-positive samples were more likely when samples were also positive for cocaine.
  
  
  CONCLUSIONS
  Employment-based reinforcement can maintain adherence to depot naltrexone. Future research should determine whether persistent cocaine use compromises naltrexone's effect on opiate use. Workplaces may be useful for promoting sustained adherence to depot naltrexone.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Everly
authors.forename: Anthony
authors.initials: A
authors.lastname: DeFulio
authors.forename: Mikhail N
authors.initials: MN
authors.lastname: Koffarnus
authors.forename: Jeannie-Marie S
authors.initials: JM
authors.lastname: Leoutsakos
authors.forename: Wendy D
authors.initials: WD
authors.lastname: Donlin
authors.forename: Will M
authors.initials: WM
authors.lastname: Aklin
authors.forename: Annie
authors.initials: A
authors.lastname: Umbricht
authors.forename: Michael
authors.initials: M
authors.lastname: Fingerhood
authors.forename: George E
authors.initials: GE
authors.lastname: Bigelow
authors.forename: Kenneth
authors.initials: K
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000652:urine; D003042:Cocaine / Q000652:urine; D003692:Delayed-Action Preparations; D018765:Dopamine Uptake Inhibitors / Q000652:urine; D004651:Employment; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000652:urine; D017063:Outcome Assessment, Health Care; D012054:Reinforcement, Psychology; D012456:Salaries and Fringe Benefits; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D018765:Dopamine Uptake Inhibitors; D009292:Narcotic Antagonists; D009271:Naltrexone; D003042:Cocaine