title: A demonstration project implementing extended-release naltrexone in Los Angeles County.
abstract: BACKGROUND
  Extended-released naltrexone (XR-NTX) is a Food and Drug Administration (FDA)-approved medication associated with higher rates of abstinence, reduced cravings, and delayed relapse to use. However, there is a dearth of literature on real-world implementation of XR-NTX. The Los Angeles County Department of Public Health, in collaboration with UCLA Integrated Substance Abuse Programs, developed a demonstration project to increase access to XR-NTX. This article describes that project, along with data on the expansion of XR-NTX service delivery and patient uptake.
  
  
  METHODS
  A secondary descriptive data analysis of demographics, substance use history, current substance use behaviors, health-related variables, and dosing records was conducted on 609 patients who received XR-NTX from Los Angeles County substance use disorder (SUD) treatment facilities from April 2010 through July 2013. A geographic information system approach mapped the distribution of XR-NTX-referring agencies across Los Angeles County.
  
  
  RESULTS
  Of the 609 records analyzed, a majority of patients (64%) obtained more than 1 dose of XR-NTX. Most XR-NTX patients reported alcohol use disorder (71.9%; n = 438). Compared with the general Los Angeles County substance use disorder patients, XR-NTX recipients reported more severe substance use histories. Finally, XR-NTX was accessed by providers in 6 of the 8 Service Planning Areas of Los Angeles County.
  
  
  CONCLUSIONS
  These findings reflect a higher XR-NTX cessation rate and a lower average number of doses, in contrast to similar demonstration projects in community settings with patients on parole or probation. However, this study shows that it is feasible to engage treatment providers in the use XR-NTX among their patients with alcohol or opioid use disorders. Several implications for future research and implementation are discussed.
authors.affiliation: a Integrated Substance Abuse Programs , University of California , Los Angeles , California , USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Cousins
authors.affiliation: b Division of Substance Abuse Prevention and Control, Los Angeles County Department of Public Health , Los Angeles , California , USA.
authors.forename: Loretta
authors.initials: L
authors.lastname: Denering
authors.affiliation: a Integrated Substance Abuse Programs , University of California , Los Angeles , California , USA.
authors.forename: Desirée
authors.initials: D
authors.lastname: Crèvecoeur-MacPhail
authors.affiliation: b Division of Substance Abuse Prevention and Control, Los Angeles County Department of Public Health , Los Angeles , California , USA.
authors.forename: John
authors.initials: J
authors.lastname: Viernes
authors.affiliation: c Division of Substance Abuse Prevention and Control, Los Angeles County Department of Public Health , Alhambra , California , USA.
authors.forename: Wayne
authors.initials: W
authors.lastname: Sugita
authors.affiliation: c Division of Substance Abuse Prevention and Control, Los Angeles County Department of Public Health , Alhambra , California , USA.
authors.forename: James
authors.initials: J
authors.lastname: Barger
authors.affiliation: c Division of Substance Abuse Prevention and Control, Los Angeles County Department of Public Health , Alhambra , California , USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Kim
authors.affiliation: d Department of Psychology , California State University Dominguez Hills , Carson , California , USA.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Weimann
authors.affiliation: a Integrated Substance Abuse Programs , University of California , Los Angeles , California , USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Rawson
mesh_terms: D000328:Adult; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D015141:Los Angeles; D008297:Male; D009271:Naltrexone / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000188:drug therapy; D016730:Program Development; D055815:Young Adult
chemical_list: D003692:Delayed-Action Preparations; D009292:Narcotic Antagonists; D009271:Naltrexone
keywords: Alcohol use disorder; XR-NTX; evidence-based practice; implementation; medication-assisted treatment; naltrexone; opioid use disorder