Healthcare utilization in adults with opioid dependence receiving extended release naltrexone compared to treatment as usual

William E. Soares, Donna Wilson, Niels Rathlev, Joshua Lee, Michael Gordon, Edward V. Nunes, Charles P. O'Brien, Peter D. Friedmann

Research output: Contribution to journalArticle

Abstract

Background: Opioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12. months post-treatment follow up. Methods: This retrospective exploratory analysis uses data collected in a published randomized trial. Comparisons of the number of emergency department visits and hospital admissions (for drug detox, psychiatric care and other medical reasons) were performed using chi square tests for any admission and negative binomial models for number of admissions. Results: Of the 308 participants randomized, 96% had utilization data (76% complete 6. months, 67% complete follow up). No significant differences were seen in overall healthcare utilization (IRR = 0.88, 95%CI 0.63-1.23, p = 0.45), or substance use-related drug detox hospitalizations (IRR = 0.83, 95%CI 0.32-2.16, p = 0.71). Despite having more participants report chronic medical problems at baseline (43% vs. 32%, p = 0.05), those receiving XR-NTX generally experienced equivalent or lower rates of healthcare utilization compared to TAU. The XR-NTX group had significantly lower medical/surgical related hospital admissions (IRR = 0.55, 95%CI 0.30-1.00, p = 0.05) during the course of the entire study. Conclusions: XR-NTX did not significantly increase rates of healthcare utilization compared to TAU. Provider concerns regarding healthcare utilization should not preclude the consideration of XR-NTX as therapy for opioid use disorders.

Original languageEnglish (US)
JournalJournal of Substance Abuse Treatment
DOIs
StateAccepted/In press - Oct 1 2016

Fingerprint

Naltrexone
Opioid Analgesics
Delivery of Health Care
Therapeutics
Hospital Emergency Service
Hospitalization
Criminal Law
Statistical Models
Chi-Square Distribution
Pharmaceutical Preparations
Psychiatry
Inpatients
Cause of Death

Keywords

  • Criminal justice population
  • Healthcare utilization
  • Long acting naltrexone
  • Opioid use disorders

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Phychiatric Mental Health
  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Healthcare utilization in adults with opioid dependence receiving extended release naltrexone compared to treatment as usual. / Soares, William E.; Wilson, Donna; Rathlev, Niels; Lee, Joshua; Gordon, Michael; Nunes, Edward V.; O'Brien, Charles P.; Friedmann, Peter D.

In: Journal of Substance Abuse Treatment, 01.10.2016.

Research output: Contribution to journalArticle

Soares, William E. ; Wilson, Donna ; Rathlev, Niels ; Lee, Joshua ; Gordon, Michael ; Nunes, Edward V. ; O'Brien, Charles P. ; Friedmann, Peter D. / Healthcare utilization in adults with opioid dependence receiving extended release naltrexone compared to treatment as usual. In: Journal of Substance Abuse Treatment. 2016.
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abstract = "Background: Opioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12. months post-treatment follow up. Methods: This retrospective exploratory analysis uses data collected in a published randomized trial. Comparisons of the number of emergency department visits and hospital admissions (for drug detox, psychiatric care and other medical reasons) were performed using chi square tests for any admission and negative binomial models for number of admissions. Results: Of the 308 participants randomized, 96{\%} had utilization data (76{\%} complete 6. months, 67{\%} complete follow up). No significant differences were seen in overall healthcare utilization (IRR = 0.88, 95{\%}CI 0.63-1.23, p = 0.45), or substance use-related drug detox hospitalizations (IRR = 0.83, 95{\%}CI 0.32-2.16, p = 0.71). Despite having more participants report chronic medical problems at baseline (43{\%} vs. 32{\%}, p = 0.05), those receiving XR-NTX generally experienced equivalent or lower rates of healthcare utilization compared to TAU. The XR-NTX group had significantly lower medical/surgical related hospital admissions (IRR = 0.55, 95{\%}CI 0.30-1.00, p = 0.05) during the course of the entire study. Conclusions: XR-NTX did not significantly increase rates of healthcare utilization compared to TAU. Provider concerns regarding healthcare utilization should not preclude the consideration of XR-NTX as therapy for opioid use disorders.",
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AB - Background: Opioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12. months post-treatment follow up. Methods: This retrospective exploratory analysis uses data collected in a published randomized trial. Comparisons of the number of emergency department visits and hospital admissions (for drug detox, psychiatric care and other medical reasons) were performed using chi square tests for any admission and negative binomial models for number of admissions. Results: Of the 308 participants randomized, 96% had utilization data (76% complete 6. months, 67% complete follow up). No significant differences were seen in overall healthcare utilization (IRR = 0.88, 95%CI 0.63-1.23, p = 0.45), or substance use-related drug detox hospitalizations (IRR = 0.83, 95%CI 0.32-2.16, p = 0.71). Despite having more participants report chronic medical problems at baseline (43% vs. 32%, p = 0.05), those receiving XR-NTX generally experienced equivalent or lower rates of healthcare utilization compared to TAU. The XR-NTX group had significantly lower medical/surgical related hospital admissions (IRR = 0.55, 95%CI 0.30-1.00, p = 0.05) during the course of the entire study. Conclusions: XR-NTX did not significantly increase rates of healthcare utilization compared to TAU. Provider concerns regarding healthcare utilization should not preclude the consideration of XR-NTX as therapy for opioid use disorders.

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