Extended-release naltrexone for treatment of alcohol dependence in primary care

New York University School of Medicine, New York, NY 10010, USA.
Journal of substance abuse treatment (Impact Factor: 2.9). 04/2010; 39(1):14-21. DOI: 10.1016/j.jsat.2010.03.005
Source: PubMed


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.

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    • "Studies document the efficacy and tolerability of the extended-release formulation in clinical trials (Garbutt et al., 2005; Lapham, Forman, Alexander, Illeperuma, & Bohn, 2009), effectiveness in primary care for treatment of alcohol dependence (Lee, Grossman, DiRocco, et al., 2010) and use with drunken driving offenders (Finigan, Perkins, Zold-Kilbourn, Parks & Stringer, 2011). "
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    ABSTRACT: The Medication Research Partnership (a national health plan and nine addiction treatment centers contracted with the health plan) sought to facilitate the adoption of pharmacotherapy for alcohol and opioid use disorders. Qualitative analysis of interviews with treatment center change leaders, individuals working for the manufacturer and its technical assistance contractor, and health plan managers extracted details on the processes used to order, store, bill for, and administer extended-release naltrexone. Qualitative themes were categorized using domains from the Consolidated Framework for Implementation Research (intervention characteristics, outer setting, inner setting, and provider characteristics). Characteristics of XR-NTX that inhibited use included the complexity of ordering and using the medication; cost was also a barrier. Outer setting barriers reflected patient needs and external health plan policies on formulary coverage, benefit management, and reimbursement. Program structures, the lack of physician linkages, a culture resistant to the use of medication, and unease with change were inner setting elements that limited use of XR-NTX. Patient stereotypes and a lack of knowledge about XR-NTX affected practitioner willingness to treat patients and prescribe XR-NTX. The Consolidated Framework for Implementation Research provided a useful lens to understand and interpret the processes affecting access to XR-NTX.
    Full-text · Article · Nov 2015 · Journal of substance abuse treatment
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    • "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). "
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    ABSTRACT: In Peru, the HIV epidemic is concentrated in men who have sex with men (MSM) and transgender women (TGW). Multiple studies correlate alcohol use disorders (AUDs) with risky sexual behaviors among Peruvian MSM. Qualitative research was used to inform a clinical trial on the acceptability of medication-assisted therapies to assist management of AUDs and improve antiretroviral therapy (ART) adherence among MSM/TGW in Peru. Three focus groups involving HIV-infected or HIV-uninfected MSM/TGW (n = 26) with AUDs (AUDIT ≥ 8) were transcribed, translated from Spanish into English, and analyzed using thematic content analysis. Despite having an AUD, participants considered themselves "social" drinkers, minimized their drinking behaviors, and differed about whether or not alcohol problems could be treated. Participants expressed skepticism about medication for treating AUDs. Three concepts emerged as necessary components of a treatment program for alcohol problems: cost, family support, and the potential to drink less alcohol without attaining total abstinence. This study reveals important areas of education to increase potential acceptability of a medication for treating AUDs among MSM/TGW. Given the social conditions and knowledge base of the participants, medication-assisted therapies using naltrexone may be a beneficial strategy for MSM with AUDs. © The Author(s) 2015.
    Full-text · Article · Mar 2015 · American journal of men's health
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    • "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). "
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    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.
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