Patient characteristics associated with initiation of XR-naltrexone for opioid use disorder in clinical trials.
Detoxification
Naltrexone
Opioid use disorder
Journal
Drug and alcohol dependence
ISSN: 1879-0046
Titre abrégé: Drug Alcohol Depend
Pays: Ireland
ID NLM: 7513587
Informations de publication
Date de publication:
01 04 2022
01 04 2022
Historique:
received:
04
10
2021
revised:
26
01
2022
accepted:
29
01
2022
pubmed:
9
2
2022
medline:
26
4
2022
entrez:
8
2
2022
Statut:
ppublish
Résumé
Extended-release injectable naltrexone (XR-naltrexone) is effective for treatment of patients with opioid use disorder (OUD), but initiation remains a barrier due to the challenge of tolerating opioid withdrawal prior to administration. Understanding factors associated with successful initiation of XR-naltrexone could facilitate its implementation through patient-treatment matching. We combined data from five consecutive studies that sought to initiate patients with active opioid use onto XR-naltrexone using a rapid procedure consisting of minimal buprenorphine, non-opioid medications for treating opioid withdrawal, and ascending low doses of oral naltrexone. Associations between patient characteristics and initiating naltrexone were estimated with logistic regression models. To evaluate whether associations differed between inpatient and outpatient settings, patient characteristic-by-setting interactions were also estimated. 409 patients were included in the analyses and 228 (56%) received the first injection. A significantly greater percent of inpatients (62%) vs outpatients (48%) initiated XR-naltrexone. Initiation success was significantly more likely on an inpatient basis for heroin (60.9% inpatient vs 36.2% outpatient), intravenous (56.3% inpatient vs 22.5% outpatient), and speedball users (68.1% inpatient vs 32.3% outpatient). Prescription opioid users showed similar, higher initiation rates across settings (68.9% inpatient; 73.7% outpatient). An inpatient setting may be the preferred strategy for rapid initiation of XR-naltrexone for opioid users with greater severity, including heroin or speedball injection users or those who use opioids intravenously. Initiation on an outpatient basis may be more likely to succeed for prescription opioid users.
Sections du résumé
BACKGROUND
Extended-release injectable naltrexone (XR-naltrexone) is effective for treatment of patients with opioid use disorder (OUD), but initiation remains a barrier due to the challenge of tolerating opioid withdrawal prior to administration. Understanding factors associated with successful initiation of XR-naltrexone could facilitate its implementation through patient-treatment matching.
METHODS
We combined data from five consecutive studies that sought to initiate patients with active opioid use onto XR-naltrexone using a rapid procedure consisting of minimal buprenorphine, non-opioid medications for treating opioid withdrawal, and ascending low doses of oral naltrexone. Associations between patient characteristics and initiating naltrexone were estimated with logistic regression models. To evaluate whether associations differed between inpatient and outpatient settings, patient characteristic-by-setting interactions were also estimated.
RESULTS
409 patients were included in the analyses and 228 (56%) received the first injection. A significantly greater percent of inpatients (62%) vs outpatients (48%) initiated XR-naltrexone. Initiation success was significantly more likely on an inpatient basis for heroin (60.9% inpatient vs 36.2% outpatient), intravenous (56.3% inpatient vs 22.5% outpatient), and speedball users (68.1% inpatient vs 32.3% outpatient). Prescription opioid users showed similar, higher initiation rates across settings (68.9% inpatient; 73.7% outpatient).
CONCLUSIONS
An inpatient setting may be the preferred strategy for rapid initiation of XR-naltrexone for opioid users with greater severity, including heroin or speedball injection users or those who use opioids intravenously. Initiation on an outpatient basis may be more likely to succeed for prescription opioid users.
Identifiants
pubmed: 35131528
pii: S0376-8716(22)00080-1
doi: 10.1016/j.drugalcdep.2022.109343
pmc: PMC8957614
mid: NIHMS1777960
pii:
doi:
Substances chimiques
Analgesics, Opioid
0
Delayed-Action Preparations
0
Narcotic Antagonists
0
Naltrexone
5S6W795CQM
Heroin
70D95007SX
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
109343Subventions
Organisme : NIDA NIH HHS
ID : R01 DA010746
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA015822
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA027124
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA030484
Pays : United States
Informations de copyright
Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.
Références
Am J Drug Alcohol Abuse. 2020 May 3;46(3):289-296
pubmed: 31860366
Psychiatry Res. 2011 Apr 30;186(2-3):159-64
pubmed: 20728943
JAMA Psychiatry. 2017 Dec 1;74(12):1197-1205
pubmed: 29049469
Am J Epidemiol. 2010 Mar 1;171(5):624-32
pubmed: 20106935
Drug Alcohol Depend. 2009 Jan 1;99(1-3):248-60
pubmed: 18986774
Am J Psychiatry. 2017 May 1;174(5):459-467
pubmed: 28068780
Lancet. 2018 Jan 27;391(10118):309-318
pubmed: 29150198
J Subst Abuse Treat. 2016 Jul;66:48-53
pubmed: 27211996
Drug Alcohol Depend. 2015 Sep 1;154:38-45
pubmed: 26187456
Arch Gen Psychiatry. 1992 Aug;49(8):630-6
pubmed: 1637253
Psychol Sci. 2008 Oct;19(10):1037-44
pubmed: 19000215
Lancet. 2011 Apr 30;377(9776):1506-13
pubmed: 21529928
J Subst Abuse Treat. 2014 May-Jun;46(5):546-52
pubmed: 24560438
Am J Psychiatry. 2019 Feb 1;176(2):129-137
pubmed: 30336703
J Addict Med. 2011 Jun;5(2):110-4
pubmed: 21769056
Psychopharmacology (Berl). 2002 Feb;159(4):351-60
pubmed: 11823887
Drug Alcohol Depend. 2014 May 1;138:83-8
pubmed: 24602363
J Clin Psychiatry. 1998;59 Suppl 20:22-33;quiz 34-57
pubmed: 9881538
Neuropsychopharmacology. 2013 Jul;38(8):1557-65
pubmed: 23443718
Drug Alcohol Depend. 2013 Jul 1;131(1-2):112-8
pubmed: 23333292
Drug Alcohol Depend. 2017 Oct 1;179:213-219
pubmed: 28806638
JAMA Netw Open. 2020 Feb 5;3(2):e1920622
pubmed: 32022884
Addict Biol. 2009 Apr;14(2):204-13
pubmed: 18715283
Addict Sci Clin Pract. 2017 Mar 28;12(1):9
pubmed: 28347350
J Subst Abuse Treat. 2018 Mar;86:86-93
pubmed: 29415856
Clin Psychol Rev. 2013 Dec;33(8):1010-24
pubmed: 24029221
BMJ Case Rep. 2014 Sep 22;2014:
pubmed: 25246463
Am J Drug Alcohol Abuse. 2001 Aug;27(3):441-52
pubmed: 11506261
J Subst Abuse Treat. 2018 Feb;85:49-55
pubmed: 28473233
J Subst Abuse Treat. 2011 Jan;40(1):56-66
pubmed: 21036514
Am J Addict. 2018 Apr;27(3):177-187
pubmed: 29596725
J Subst Abuse Treat. 2018 Nov;94:55-59
pubmed: 30243418
Am J Addict. 2009 Jul-Aug;18(4):301-8
pubmed: 19444734
Addict Behav. 2009 Mar;34(3):319-22
pubmed: 19022584
J Subst Abuse Treat. 2018 Feb;85:38-44
pubmed: 28449955
Addiction. 2005 Aug;100(8):1090-100
pubmed: 16042639
Drug Alcohol Depend. 2018 Jun 1;187:171-178
pubmed: 29674251
Front Pharmacol. 2016 Jun 28;7:187
pubmed: 27445822
Drug Alcohol Depend. 2012 Feb 1;121(1-2):152-8
pubmed: 21925804
Am J Drug Alcohol Abuse. 2012 May;38(3):187-99
pubmed: 22404717
Am J Addict. 2015 Apr;24(3):258-264
pubmed: 25907815
Arch Pediatr Adolesc Med. 2006 Jul;160(7):739-46
pubmed: 16818840
J Subst Abuse Treat. 2020 Feb;109:80-85
pubmed: 31810594