title: Adoption of injectable naltrexone in U.S. substance use disorder treatment programs.
abstract: OBJECTIVE
  Medication-assisted treatment for substance use disorders (SUDs) is not widely used in treatment programs. The aims of the current study were to document the prevalence of adoption and implementation of extended-release injectable naltrexone, the newest U.S. Food and Drug Administration-approved medication for alcohol use disorder (AUD), in U.S. treatment programs and to examine associations between organizational and patient characteristics and adoption.
  
  
  METHODS
  The study used interview data from a nationally representative sample of 307 U.S. SUD treatment programs to examine adoption and implementation of injectable naltrexone.
  
  
  RESULTS
  Thirteen percent of programs used injectable naltrexone for AUD, and 3% of programs used it for opioid use disorder. Every treatment program that offered injectable naltrexone to its patients used it in conjunction with psychosocial treatment, particularly cognitive behavioral therapy. Multivariate logistic regression results indicated that adoption was positively associated with the provision of wraparound services, the percentage of privately insured patients, and the presence of inpatient detoxification services. For-profit status and offering inpatient services were negatively associated with adoption. Within adopting programs, an average of 4.1% of AUD patients and 7.1% of patients with opioid use disorder were currently receiving the medication, despite clinical directors' reports of positive patient outcomes, particularly for relapsers and for those who had been noncompliant with other medications. Cost was a significant issue for the majority of adopting organizations.
  
  
  CONCLUSIONS
  The rate of adoption of injectable naltrexone in U.S. treatment programs remains limited. Researchers should continue to examine patient, organizational, and external characteristics associated with the adoption and implementation of injectable naltrexone over time.
authors.affiliation: Owens Institute for Behavioral Research, University of Georgia, Athens, Georgia.
authors.forename: Lydia
authors.initials: L
authors.lastname: Aletraris
authors.affiliation: Owens Institute for Behavioral Research, University of Georgia, Athens, Georgia.
authors.forename: Mary
authors.initials: M
authors.lastname: Bond Edmond
authors.affiliation: Owens Institute for Behavioral Research, University of Georgia, Athens, Georgia.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Roman
mesh_terms: D019973:Alcohol-Related Disorders / Q000188:drug therapy*; D006801:Humans; D009271:Naltrexone / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D009271:Naltrexone