Adapting treatment length to opioid‐dependent individuals’ needs and preferences: a 2‐year follow‐up to a 1‐year study of extended‐release naltrexone

Abstract

Background and aims Extended‐release naltrexone (XR‐NTX) is an under‐used treatment option for opioid dependence, today only available in a few countries in the world. Although effective, safe and feasible in short‐term treatment, long‐term data are scarce and there is no recommendation for required treatment length. The aims of the study were to determine the perceived need of long‐term XR‐NTX treatment and to examine long‐term treatment outcomes. Design In this prospective cohort study, following a parent 1‐year study of XR‐NTX, participants received treatment with XR‐NTX at their own discretion for a maximum of 104 weeks. Setting and participants Five urban, outpatient addiction clinics in Norway, comprising opioid‐dependent adults aged 18–60 years (n = 50) already participating in the parent study. Intervention XR‐NTX administered as intramuscular injections (380 mg) every 4 weeks. Measurements Time in the study, use of opioids and other illicit substances, opioid craving and treatment satisfaction reported every 4 weeks. Findings Among 58 participants who completed the 1‐year parent study, 50 chose to continue the treatment with XR‐NTX. Median prolonged treatment time was 44.0 weeks [95% confidence interval (CI) = 25.5–62.5], ranging from 8 to 104 weeks. Most participants (35, 70%) reported no relapse to opioid use during treatment while a subgroup (15, 30%) reported relapses to opioids during the study. Scores for mean treatment satisfaction and recommending treatment to others were very high (>9) and mean opioid craving score was very low (<1) on a scale ranging from 0 to 10. Conclusions Extended‐release naltrexone (XR‐NTX) was well tolerated in long‐term treatment of opioid‐dependent individuals in Norway already in XR‐NTX treatment. On average, the participants chose to continue treatment for almost 1 year beyond the initial 9–12 months of treatment. Participants reported high treatment satisfaction and 70% showed no relapse to opioids during the treatment period.

‘Not at all what I had expected’: Discontinuing treatment with extended-release naltrexone (XR-NTX): A qualitative study

“…However, experiences of satisfactorily reaching opioid abstinence after a few injections are in line with previous and current clinical observations of the phenomenon, and provide nuance to the understanding of early discontinuation of treatment as indicative of failed treatment (Dennis et al, 2020;Walker, 2009). It also supplements earlier findings from Solli et al (2020), who suggested that some XR-NTX patients might need longer than a year to reach their treatment goal. Findings from the current study suggest that for some, personal treatment goals may be achieved earlier than the framework of a clinical trial allows.…”

“…Choosing to participate, despite the apprehension some expressed toward XR-NTX, might be understood as a last hope for help that would contribute to a better life (Jackson et al, 2003). However, many participants described not receiving adequate psychosocial support, which previous research has suggested can be a reason for discontinuation of treatment with XR-NTX (Solli et al, 2020). Studies have found that a supportive relationship with a therapist can predict significantly longer retention in outpatient treatment, often regardless of treatment type (Elliott et al, 2018;Hatcher & Barends, 1996;Jinks, 1999;Kasarabada et al, 2002;McLellan et al, 1988;Najavits et al, 2000;Redko et al, 2007).…”

Patients’ experiences of continued treatment with extended-release naltrexone: a Norwegian qualitative study

“…A previous randomized controlled trial [ 2 ] demonstrated that XR-NTX is as safe and effective as buprenorphine-naloxone (an opioid agonist). The results were consistent with other studies [ 4 , 38 – 41 ], showing a decrease in opioid and substance use, improvements on psychosocial variables, and less opioid craving [ 3 , 42 – 44 ]. The need for XR-NTX to be reinforced by psychosocial interventions or psychological treatment [ 45 – 47 ] has been emphasized, while a lack of psycho-social follow-up has been linked to treatment discontinuation [ 44 ].…”

What lessons from Norway’s experience could be applied in the United States in response to the addiction and overdose crisis?

“…Access to OAT for large numbers of currently untreated people will be required. Similarly, access to evidence‐based treatments such as depot naltrexone [8, 9] will allow meeting the varied needs among OUD populations. Currently, in the United States, only approximately one‐third of those in need receive treatment [10].…”