Opioid treatment at release from jail using extended-release naltrexone: A pilot proof-of-concept randomized effectiveness trial

Joshua D. Lee, Ryan Mcdonald, Ellie Grossman, Jennifer Mcneely, Eugene Laska, John Rotrosen, Marc N. Gourevitch

Research output: Contribution to journalArticle

Abstract

Background and Aims: Relapse to addiction following incarceration is common. We estimated the feasibility and effectiveness of extended-release naltrexone (XR-NTX) as relapse prevention among opioid-dependent male adults leaving a large urban jail. Design: Eight-week, proof-of-concept, open-label, non-blinded randomized effectiveness trial. Setting: New York City jails and Bellevue Hospital Center Adult Primary Care clinics, USA. Participants: From January 2010 to July 2013, 34 opioid-dependent adult males with no stated interest in agonist treatments (methadone, buprenorphine) received a counseling and referral intervention and were randomized to XR-NTX (n=17) versus no medication (n=17) within one week prior to jail release. Intervention: XR-NTX (Vivitrol®; Alkermes Inc.), a long-acting injectable mu opioid receptor antagonist. Measures: The primary intent-to-treat outcome was post-release opioid relapse at week 4, defined as ≥10days of opioid misuse by self-report and urine toxicologies. Secondary outcomes were proportion of urine samples negative for opioids and rates of opioid abstinence, intravenous drug use (IVDU), cocaine use, community treatment participation, re-incarceration and overdose. Findings: Acceptance of XR-NTX was high; 15 of 17 initiated treatment. Rates of the primary outcome of week 4 opioid relapse were lower among XR-NTX participants: 38 versus 88% [P<0.004; odds ratio (OR)=0.08, 95% confidence interval (CI)=0.01-0.48]; more XR-NTX urine samples were negative for opioids, 59 versus 29% (P<0.009; OR=3.5, 95% CI=1.4-8.5). There were no significant differences in the remaining secondary outcomes, including rates of IVDU, cocaine use, re-incarceration and overdose. Conclusion: Extended-release naltrexone is associated with significantly lower rates of opioid relapse among men in the United States following release from jail when compared with a no medication treatment-as-usual condition.

Original languageEnglish (US)
Pages (from-to)1008-1014
Number of pages7
JournalAddiction
Volume110
Issue number6
DOIs
StatePublished - Jun 1 2015

Keywords

  • Extended-release naltrexone
  • Jail
  • Opioid dependence
  • Prisoners
  • Randomized controlled trial
  • Relapse prevention
  • Vivitrol

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

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