title: Effects of injectable extended-release naltrexone (XR-NTX) for opioid dependence on residential rehabilitation outcomes and early follow-up.
abstract: OBJECTIVE
  Little is known about the use of extended-release naltrexone (XR-NTX) during residential rehabilitation, and its effects on early outcomes and rates of follow-up treatment. This study examined patient characteristics and rates of treatment completion and engagement in post-residential care of opioid dependent patients who received XR-NTX during residential rehabilitation, compared with patients who did not receive this medication.
  
  
  METHODS
  Electronic records for opioid dependent patients from three Pennsylvania residential detoxification and treatment facilities (N = 7,687) were retrospectively analyzed. We determined the proportion of patients who received XR-NTX (INJ), and compared rates of treatment completion and engagement in follow-up care relative to a naturalistic control group of patients recommended for, but not administered, XR-NTX (Non-INJ). Data on whether the patient initiated follow-up care were available from one site (N = 3,724).
  
  
  RESULTS
  Overall, 598 (7.8%) patients were recommended for XR-NTX and of these, 168 (28.1%) received injections. Compared to non-INJ patients, INJ patients were less likely to leave against medical advice (4.8% vs. 30.2%, p < .001) and more likely to initiate follow-up care (37.7% vs. 19.7%, p < .001). These differences remained significant after controlling for demographic covariates using regression analysis.
  
  
  CONCLUSIONS
  XR-NTX was associated with higher rates of residential and early post-residential care engagement in patients with opioid dependence.
  
  
  CONCLUSIONS
  XR-NTX may be an effective adjunct in the residential treatment and aftercare of patients with opioid dependence.
authors: Department of Public Health Sciences, Center for Applied Studies in Health Economics, Penn State College of Medicine, Hershey, Pennsylvania.|Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania.
authors: Douglas L
authors: DL
authors: Leslie
authors: Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania.
authors: William
authors: W
authors: Milchak
authors: Treatment Research Institute, Philadelphia, PA.
authors: David R
authors: DR
authors: Gastfriend
authors: CRC Health Group, Inc., Cupertino, California.
authors: Philip L
authors: PL
authors: Herschman
authors: Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania.
authors: Edward O
authors: EO
authors: Bixler
authors: Department of Public Health Sciences, Center for Applied Studies in Health Economics, Penn State College of Medicine, Hershey, Pennsylvania.
authors: Diana L
authors: DL
authors: Velott
authors: Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania.
authors: Roger E
authors: RE
authors: Meyer
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D010414:Pennsylvania; D012047:Rehabilitation Centers; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D003692:Delayed-Action Preparations; D009292:Narcotic Antagonists; D009271:Naltrexone
references: Smyth B, Hoffman V, Fan J, et al. Years of potential life lost among heroin addicts 33 years after treatment. Prev Med. 2007; 44:369-374.
references: National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institute on Drug Abuse, Rockville MD, NIH Publication No.12-4180;2012.
references: Office of National Drug Control Policy. National Drug Control Strategy 2010. Washington, DC 2010: http://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/ndcs2010.pdf. Accessed July 9, 2013.
references: Jones ES, Moore BA, Sindelar JL, et al. Cost analysis of clinic and office-based treatment of opioid dependence: Results with methadone and buprenorphine in clinically stable patients. Drug Alcohol Depend. 2009; 99:132-140.
references: McCollister KE, French MT. The relative contribution of outcome domains in the total economic benefit of addiction interventions: A review of first findings. Addiction. 2003; 98:1647-1659.
references: Parthasarathy S, Mertens J, Moore C, et al. Utilization and cost impact of integrating substance abuse treatment and primary care. Medical care. 2003; 41:357-367.
references: Cartwright WS. Cost-benefit analysis of drug treatment services: Review of the literature. J Ment Health Policy Econ. 2000; 3:11-26.
references: Doran CM. Economic evaluation of interventions to treat opiate dependence: A review of the evidence. Pharmacoeconomics. 2008; 26:371-393.
references: Lennox RD, Scott-Lennox JA, Holder HD. Substance abuse and family illness: Evidence from health care utilization and cost-offset research. J Ment Health Adm. 1992; 19:83-95.
references: Ball JC, Corty E. Basic issues pertaining to the effectiveness of methadone maintenance treatment. Compulsory treatment of drug abuse: Research and clinical practice. 1988;178-191.
references: Hubbard L, Marsden E, Racholl V. Drug abuse treatment: A national study of effectiveness. Chapel Hill: The University of North Carolina Press; 1989.
references: McLellan AT, Woody GE, Luborsky L, et al. Increased effectiveness of substance abuse treatment. A prospective study of patient-treatment “matching.” J Nerv Ment Dis. 1983; 171:597-605.
references: Miller WR, Hester RK. Inpatient alcoholism treatment. Who benefits? American psychol. 1986; 41:794-805.
references: Allison M, Hubbard RL. Drug abuse treatment process: A review of the literature. Int J Addict. 1985; 20:1321-1345.
references: Willette RE. Narcotic antagonists: The search for long-acting preparations: Introduction. Natl Inst Drug Abuse Res Monogr Ser. 1975:1-5.
references: Krupitsky EM, Zvartau EE, Masalov DV, et al. Naltrexone for heroin dependence treatment in St. Petersburg, Russia. J Subst Abuse Treat. 2004; 26:285-294.
references: Krupitsky E NE, Ling W, Illeperuma A, et al. Injectable extended-release naltrexone for opioid dependence. Lancet. 2011; 378:665.
references: Krupitsky E, Nunes EV, Ling W, et al. Injectable extended-release naltrexone (XR-NTX) for opioid dependence: Long-term safety and effectiveness. Addiction. 2013; 108:1628-1637.
references: Crèvecoeur-MacPhail DA Denering RR, Cousins LL, et al. County Angeles Evaluation System (LACES): An Outcomes Reporting Program Vivitrol Evaluation Pilot. University of California at Los Angeles Los Angeles County Department of Public Health Substance Abuse Prevention Control Santa Monica, CA., 2012, Results accessed online July 30, 2013 at: https://admin.publichealth.lacounty.gov/sapc/resources/VivitrolPilot1FinalReport.pdf.
references: Baser O, Chalk M, Fiellin DA, et al. Cost and utilization outcomes of opioid-dependence treatments. Am J Manag Care. 2011; 17:S235-S248.
references: Seo D LC, Tuit K, Hong KI, et al. Disrupted ventromedial prefrontal function, alcohol craving, and subsequent relapse risk. JAMA Psychiatry. 2013; 70:727-739.
references: Langleben DD, Busch EL, O'Brien CP, et al. Depot naltrexone decreases rewarding properties of sugar in patients with opioid dependence. Psychopharmacology. 2012; 220:559-564.