The feasibility of using extended-release injectable naltrexone (XR-NTX) to treat alcohol dependence in routine primary care settings is unknown. An open-label, observational cohort study evaluated 3-month treatment retention, patient satisfaction, and alcohol use among alcohol-dependent patients in two urban public hospital medical clinics. Adults seeking treatment were offered monthly medical management (MM) and three XR-NTX injections (380 mg, intramuscular). Physician-delivered MM emphasized alcohol abstinence, medication effects, and accessing mutual help and counseling resources. Seventy-two alcohol-dependent patients were enrolled; 90% (65 of 72) of eligible subjects received the first XR-NTX injection; 75% (49 of 65) initiating treatment received the second XR-NTX injection; 62% (40 of 65), the third. Among the 56% (n = 40) receiving three injections, median drinks per day decreased from 4.1 (95% confidence interval = 2.9-6) at baseline to 0.5 (0-1.7) during Month 3. Extended-release naltrexone delivered in a primary care MM model appears a feasible and acceptable treatment for alcohol dependence.
"NTX decreases days of heavy drinking (Anton et al., 2006) and alcohol relapse (Streeton & Whelan, 2001) and is superior to acamprosate and/or behavioral counseling (Anton et al., 2006). Once-monthly injectable extended-release naltrexone (XR-NTX) confers an adherence advantage (Garbutt et al., 2005; Swift, 2007) over daily oral formulations and is feasible for use in primary care settings (Lee et al., 2010). XR-NTX administration combined with brief medical management counseling reduces alcohol consumption even during holiday periods where heavy drinking is common (Lapham, Forman, Alexander, Illeperuma, & Bohn, 2009). "
"National consensus standards, moreover, recommend pharmacotherapy (National Quality Forum, 2007) and both alcohol and opioid dependence can be successfully addressed in primary care settings (Sullivan, Tetrault, Braithwaite, Turner, & Fiellin, 2011). Finally, physicians have used XR-NTX successfully in both hospital and community-based general internal medicine practices (Lee et al., 2010). "
[Show abstract][Hide abstract] ABSTRACT: Through improved adherence, once-monthly injectable extended-release naltrexone (XR-NTX) may provide an advantage over other oral agents approved for alcohol and opioid dependence treatment. The objective of this study was to evaluate cost and utilization outcomes between XR-NTX and other pharmacotherapies for treatment of alcohol and opioid dependence. Published studies were identified through comprehensive search of two electronic databases. Studies were included if they compared XR-NTX to other approved medicines and reported economic and healthcare utilization outcomes in patients with opioid or alcohol dependence. We identified five observational studies comparing 1,565 patients using XR-NTX to other therapies over six months. Alcohol dependent XR-NTX patients had longer medication refill persistence versus acamprosate and oral naltrexone. Healthcare utilization and costs was generally lower or as low for XR-NTX-treated patients relative to other alcohol dependence agents. Opioid dependent XR-NTX patients had lower inpatient substance abuse-related utilization versus other agents and $8170 lower total cost versus methadone.
"The medication showed efficacy in decreasing drinking days and decreasing the event rate of heavy drinking days compared to placebo (Garbutt et al., 2005), as well as efficacy in prolonging abstinence and reducing the number of drinking days and heavy drinking days in patients that were abstinent for as few as four days before beginning treatment (O'Malley et al., 2007). While injectable naltrexone addresses the issue of daily patient compliance, the cost of the medication has been cited as a major barrier to adoption in community based substance abuse treatment programs (Abraham & Roman, 2010; Lee et al., 2010). "
[Show abstract][Hide abstract] ABSTRACT: Alcohol use disorders (AUDs) continue to be one of the most pervasive and costly of the substance use disorders (SUDs). Despite evidence of clinical effectiveness, adoption of medications for the treatment of AUDs is suboptimal. Low rates of AUD medication adoption have been explained by characteristics of both treatment organizations and individual counselor's attitudes and behaviors. However, few studies have simultaneously examined the impact of organizational-level and counselor-level characteristics on counselor perceptions of EBPs. To address this gap in the literature, we use data from a national sample of 1178 counselors employed in 209 privately funded treatment organizations to examine the effects of organizational and individual counselor characteristics on counselor attitudes toward tablet and injectable naltrexone. Results of hierarchical linear modeling (HLM) show that organizational characteristics (use of tablet/injectable naltrexone in the program, 12-step orientation) were associated with counselor perceptions of naltrexone. Net of organizational characteristics, several counselor level characteristics were associated with attitudes toward tablet and injectable naltrexone including gender, tenure in the field, recovery status, percentage of AUD patients, and receipt of medication-specific training. These findings reveal that counselor receptiveness toward naltrexone is shaped in part by the organizational context in which counselors are embedded.
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