Extended-release naltrexone opioid treatment at jail reentry (XOR)

Ryan D. McDonald, Babak Tofighi, Eugene Laska, Keith Goldfeld, Wanda Bonilla, Mara Flannery, Nadina Santana-Correa, Christopher W. Johnson, Neil Leibowitz, John Rotrosen, Marc N. Gourevitch, Joshua D. Lee

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Extended-release naltrexone (XR-NTX) is an injectable monthly sustained-release mu opioid receptor antagonist, which blocks the typical effects of heroin and other opioid agonists. Use of XR-NTX among opioid dependent persons leaving jails and prisons is increasing despite scant high-quality evidence regarding XR-NTX's effectiveness at re-entry. Methods: This 24-week, open-label randomized controlled trial examines the effectiveness of XR-NTX as opioid relapse prevention at release from jail (N = 85) compared to enhanced treatment as usual (ETAU, N = 85). A third, non-randomized, quasi-experimental naturalistic arm of participants who have newly initiated a jail-to-community methadone treatment program (MTP, N = 85) allows for comparisons to a methadone standard-of-care. Results: We describe the rationale, design, and primary and secondary outcomes of the study. The primary outcome is an opioid relapse event; the primary contrast is a time-to-relapse comparison of XR-NTX and ETAU over a 24-week treatment phase. Secondary outcomes are rates of: (a) post-release opioid treatment participation, (b) opioid, alcohol, and cocaine use, (c) injection drug use and HIV sexual risk behaviors, (d) overdose (fatal and non-fatal) and all-cause mortality, and, (e) re-incarceration. Conclusions: XR-NTX is a potentially important, effective treatment and relapse prevention option for a large US population of persons with opioid use disorders leaving jails. This study will estimate XR-NTX's effectiveness relative to existing standards of care, including counseling-only treatment-as-usual and methadone maintenance.

Original languageEnglish (US)
Pages (from-to)57-64
Number of pages8
JournalContemporary Clinical Trials
Volume49
DOIs
StatePublished - Jul 1 2016

Keywords

  • Criminal justice
  • Extended-release naltrexone
  • Jail
  • Naltrexone
  • Opioid relapse prevention

ASJC Scopus subject areas

  • Pharmacology (medical)

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