A Naturalistic Evaluation of Extended-Release Naltrexone in Clinical Practice in Missouri.
The purpose of this study was to compare the naturalistic outcomes of individuals with alcohol or opioid use problems who were treated with extended-release naltrexone (XR-NTX) to those treated with psychosocial treatment only and also to those treated with other medication-assisted therapies in Missouri during 2010 to 2011. We analyzed intake and discharge data collected as part of SAMHSA's Treatment Episode Data Set assessments. Patients who received XR-NTX during their treatment episode were compared, for those reporting alcohol (but not opioids) as their problem (N=21,137), to those who received oral naltrexone, acamprosate, and psychosocial treatment only, and for those who reported opioids as a problem (N=8996), to those receiving oral naltrexone, buprenorphine/naloxone, and psychosocial treatment only. Group differences were adjusted using propensity score weighting, with propensity scores derived from 18 intake variables. For the alcohol sample, patients who received XR-NTX vs. the oral naltrexone group had superior composite outcomes on a measure combining abstinence, self-help participation, employment, and arrests. For the opioid sample, XR-NTX was found to have significantly better outcomes than oral naltrexone on the composite outcome measure. For both the alcohol and opioid samples, the group that received XR-NTX stayed in treatment longer vs. psychosocial treatment only. In the opioid sample, those receiving buprenorphine/naloxone remained in treatment longer than those receiving XR-NTX.
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: crits@mail.med.upenn.edu.
Paul
P
Crits-Christoph
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Hannah M
HM
Markell
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Mary Beth Connolly
MB
Gibbons
Department of Mathematics, West Chester University.
Robert
R
Gallop
Missouri Department of Mental Health, Jefferson City, MO.
Christie
C
Lundy
Missouri Department of Mental Health, Jefferson City, MO.
Mark
M
Stringer
Treatment Research Institute, Philadelphia, PA.
David R
DR
Gastfriend
D000077443:Acamprosate; D000328:Adult; D000427:Alcohol Deterrents / Q000008:administration & dosage / Q000494:pharmacology*; D019973:Alcohol-Related Disorders / Q000188:drug therapy*; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D009271:Naltrexone / Q000008:administration & dosage / Q000494:pharmacology*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D011613:Psychotherapy / Q000379:methods*; D013654:Taurine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology
D000427:Alcohol Deterrents; D003692:Delayed-Action Preparations; D009292:Narcotic Antagonists; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate
Alcohol; Extended-release naltrexone; Medication-assisted treatment; Opioids; Substance abuse