Long-term follow-up study of community-based patients receiving XR-NTX for opioid use disorders.
OBJECTIVE
Extended-release naltrexone (XR-NTX) is FDA-approved to prevent relapse in patients with Opioid Use Disorder. However little is known about long-term use among community-based outpatients.


METHODS
Retrospective chart review and long-term follow-up survey among individuals (N = 168) who entered an outpatient XR-NTX trial between 2011 and 2015, during which participants were offered three monthly injections of XR-NTX at no cost. The survey consisted of 35 questions covering a total of four domains: (1) substance use; (2) treatment continuation; (3) barriers; and (4) attitudes.


RESULTS
Fifty-seven respondents were successfully surveyed, including 50% of those initially receiving all three XR-NTX injections ("study completers") in the parent study. Study completion was associated with superior outcomes and less likely relapse (defined as daily use), with a much greater time to relapse despite higher rates of concurrent non-opioid substance use. However the majority of participants discontinued treatment with XR-NTX at study completion, largely due to attitudes of "feeling cured" and "wanting to do it on my own" rather than external barriers such as cost or side effects.


CONCLUSIONS
Patients who initiate treatment with XR-NTX might benefit from anticipatory guidance and motivational techniques to encourage long-term adherence as many will experience internal barriers to continuation. Our findings are reassuring that few patients experience side effects or adverse events complicating the effectiveness or safety of long-term use of XR-NTX.


CONCLUSIONS
Among outpatients who successfully receive 3 monthly XR-NTX injections, many will prematurely discontinue treatment due to internal attitudes, such as "feeling cured." (Am J Addict 2017;26:319-325).
Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York.|New York State Psychiatric Institute, Colombia University, New York, New york.
Arthur Robin
http://orcid.org/0000-0002-7380-6203
AR
Williams
New York State Psychiatric Institute, Colombia University, New York, New york.
Vincent
V
Barbieri
New York State Psychiatric Institute, Colombia University, New York, New york.
Kaitlyn
K
Mishlen
Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York.|New York State Psychiatric Institute, Colombia University, New York, New york.
Frances R
FR
Levin
Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York.|New York State Psychiatric Institute, Colombia University, New York, New york.
Edward V
EV
Nunes
Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York.|New York State Psychiatric Institute, Colombia University, New York, New york.
John J
JJ
Mariani
Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York.|New York State Psychiatric Institute, Colombia University, New York, New york.
Adam
A
Bisaga
D000293:Adolescent; D000328:Adult; D003692:Delayed-Action Preparations; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000523:psychology*; D010045:Outpatients; D055815:Young Adult
D003692:Delayed-Action Preparations; D009292:Narcotic Antagonists; D009271:Naltrexone