Effects of injectable extended‐release naltrexone (XR‐NTX) for opioid dependence on residential rehabilitation outcomes and early follow‐up

In April 2016, the Eunice Kennedy Shriver National Institute of Child Health and Human Development invited experts to a workshop to address numerous knowledge gaps and to review the evidence for the screening and management of opioid use in pregnancy and neonatal abstinence syndrome. The rising prevalence of opioid use in pregnancy has led to a concomitant dramatic fivefold increase in neonatal abstinence syndrome over the past decade. Experts from diverse disciplines addressed research gaps in the following areas: 1) optimal screening for opioid use in pregnancy; 2) complications of pregnancy associated with opioid use; 3) appropriate treatments for pregnant women with opioid use disorders; 4) the best approaches for detecting, treating, and managing newborns with neonatal abstinence syndrome; and 5) the long-term effects of prenatal opioid exposure on children. Workshop participants identified key scientific opportunities to advance the understanding of opioid use disorders in pregnancy and to improve outcomes for affected women, their children, and their families. This article provides a summary of the workshop presentations and discussions.

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“…(64–66) However, limited data are available on the safety and efficacy of naltrexone during pregnancy. (67, 68)…”

Section: Medication-assisted Therapymentioning

confidence: 99%

Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes

Reddy¹,

Davis²,

Ren³

et al. 2017

Obstetrics &Amp; Gynecology

215

101

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“…However, there is limited experience with this drug medication outside specialized treatment settings. XR‐NTX has frequently been offered to patients who have completed extended residential treatment15 and to patients for whom initiation of relapse‐prevention treatment with XR‐NTX was relatively uncomplicated because of current abstinence 16. Most patients in need of treatment, however, are actively using opioids at the time of initial evaluation and require completion of opioid withdrawal before XR‐NTX initiation.…”

Section: Introductionmentioning

confidence: 99%

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

et al. 2018

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Background and ObjectivesOpioid use disorder (OUD) is a chronic condition with potentially severe health and social consequences. Many who develop moderate to severe OUD will repeatedly seek treatment or interact with medical care via emergency department visits or hospitalizations. Thus, there is an urgent need to develop feasible and effective approaches to help persons with OUD achieve and maintain abstinence from opioids. Treatment that includes one of the three FDA‐approved medications is an evidence‐based strategy to manage OUD. The purpose of this review is to address practices for managing persons with moderate to severe OUD with a focus on opioid withdrawal and naltrexone‐based relapse‐prevention treatment.MethodsLiterature available on PubMed was used to review the evolution of treatment strategies from the 1960s onward to manage opioid withdrawal and initiate treatment with naltrexone.ResultsEmerging practices for extended‐release naltrexone induction include the use of agonist tapers and adjuvant medications. Clinical challenges frequently encountered when initiating this therapy include managing withdrawal and ongoing opioid use during treatment. Clinical factors may inform decisions regarding patient selection and length of naltrexone treatment, such as recent opioid use and patient preferences.Conclusions and Scientific SignificanceTreatment strategies to manage opioid withdrawal have evolved, but many patients with OUD do not receive medication for the prevention of relapse. Clinical strategies for induction onto extended‐release naltrexone are now available and can be safely and effectively implemented in specialty and select primary care settings. (© 2018 The Authors. The American Journal on Addictions Published by Wiley Periodicals, Inc. on behalf of The American Academy of Addiction Psychiatry (AAAP);27:177–187)

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“…Indeed, there is growing interest in XR-NTX treatment among OUD populations, particularly among daily heroin users (Ahamad, et al, 2015). Leslie, et al (2015) found that patients who received an initial injection of XR-NTX while in a residential setting had lower rates of AMA discharge and higher rates of transition to outpatient care than those who did not receive XR-NTX. Notably, in that study of persons leaving residential care, first appointment follow-up rates for continuing care in the first 10 days post-discharge were also low.…”

Section: 0 Discussionmentioning

confidence: 97%

“…Leslie, et al found that those who received XR-NTX while in residential treatment were less likely to leave against medical advice (AMA) and more likely to engage in follow-up care post-discharge than those who did not receive XR-NTX (Leslie, et al, 2015). …”

Section: 0 Introductionmentioning

confidence: 99%

Linkage to Primary Care for Persons First Receiving Injectable Naltrexone During Inpatient Opioid Detoxification

Stein

Risi

Bailey

et al. 2016

Journal of Substance Abuse Treatment

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Introduction Opioid use disorders commonly require ongoing medication-assisted treatment to reduce relapse following discharge from inpatient detoxification programs. Naltrexone, an opioid antagonist, is an increasingly popular treatment option in its once-monthly injectable form (XR-NTX). The aim of this study was to examine the follow-up rates of persons who received an initial injection during inpatient detoxification and scheduled for receipt of a first outpatient injection in the primary care setting. Methods We reviewed the electronic health records of 62 consecutive opioid dependent adults who received an initial injection of XR-NTX during extended inpatient detoxification at Stanley Street Treatment and Resources (SSTAR) in Fall River, Massachusetts, from March 2013 to August 2015, and were referred to the adjacent SSTAR primary care health center for their second injection one month later. Demographic information, drug use and opioid treatment history, and aftercare planning were assessed. Results Participants averaged 32.4 (±7.8) years of age, 90.3% were non-Latino Caucasian, 35.5% were homeless, 21.3% reported a drug overdose in the last year, and 53.2% had been in detoxification within the last year. Of the 62 participants referred to primary care, 34 (54.8%) followed up to receive their second XR-NTX injection. Twenty of these persons received at least a third XR-NTX injection. No demographic, treatment history, substance use behaviors, or aftercare plan variables were associated with receipt of a second injection (p<.20). Conclusion Predicting, and therefore improving, XR-NTX continuation during the transition from inpatient detoxification to primary care may be difficult in this population.

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Effects of injectable extended‐release naltrexone (XR‐NTX) for opioid dependence on residential rehabilitation outcomes and early follow‐up

Abstract: XR-NTX may be an effective adjunct in the residential treatment and aftercare of patients with opioid dependence.

Cited by 20 publications

References 18 publications

Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes

Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

Linkage to Primary Care for Persons First Receiving Injectable Naltrexone During Inpatient Opioid Detoxification

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