title: Opioid treatment at release from jail using extended-release naltrexone: a pilot proof-of-concept randomized effectiveness trial.
abstract: OBJECTIVE
  Relapse to addiction following incarceration is common. We estimated the feasibility and effectiveness of extended-release naltrexone (XR-NTX) as relapse prevention among opioid-dependent male adults leaving a large urban jail.
  
  
  METHODS
  Eight-week, proof-of-concept, open-label, non-blinded randomized effectiveness trial.
  
  
  METHODS
  New York City jails and Bellevue Hospital Center Adult Primary Care clinics, USA.
  
  
  METHODS
  From January 2010 to July 2013, 34 opioid-dependent adult males with no stated interest in agonist treatments (methadone, buprenorphine) received a counseling and referral intervention and were randomized to XR-NTX (n = 17) versus no medication (n = 17) within one week prior to jail release.
  
  
  METHODS
  XR-NTX (Vivitrol(®) ; Alkermes Inc.), a long-acting injectable mu opioid receptor antagonist.
  
  
  METHODS
  The primary intent-to-treat outcome was post-release opioid relapse at week 4, defined as ≥10 days of opioid misuse by self-report and urine toxicologies. Secondary outcomes were proportion of urine samples negative for opioids and rates of opioid abstinence, intravenous drug use (IVDU), cocaine use, community treatment participation, re-incarceration and overdose.
  
  
  RESULTS
  Acceptance of XR-NTX was high; 15 of 17 initiated treatment. Rates of the primary outcome of week 4 opioid relapse were lower among XR-NTX participants: 38 versus 88% [P<0.004; odds ratio (OR) = 0.08, 95% confidence interval (CI) = 0.01-0.48]; more XR-NTX urine samples were negative for opioids, 59 versus 29% (P<0.009; OR = 3.5, 95% CI = 1.4-8.5). There were no significant differences in the remaining secondary outcomes, including rates of IVDU, cocaine use, re-incarceration and overdose.
  
  
  CONCLUSIONS
  Extended-release naltrexone is associated with significantly lower rates of opioid relapse among men in the United States following release from jail when compared with a no medication treatment-as-usual condition.
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA.|Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Lee
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: McDonald
authors.affiliation: Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: Ellie
authors.initials: E
authors.lastname: Grossman
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA.|Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McNeely
authors.affiliation: Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Laska
authors.affiliation: Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Rotrosen
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: Marc N
authors.initials: MN
authors.lastname: Gourevitch
mesh_terms: D000328:Adult; D003692:Delayed-Action Preparations; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009271:Naltrexone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009519:New York City; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010865:Pilot Projects; D011329:Prisoners; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D003692:Delayed-Action Preparations; D009292:Narcotic Antagonists; D009271:Naltrexone
keywords: Extended-release naltrexone; Vivitrol; jail; opioid dependence; prisoners; randomized controlled trial; relapse prevention