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

Joshua Lee, Ryan Mcdonald, Ellie Grossman, Jennifer Mcneely, Eugene Laska, John Rotrosen, Marc 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

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Naltrexone
Opioid Analgesics
Recurrence
Therapeutics
Urine
Cocaine
Odds Ratio
Confidence Intervals
Buprenorphine
Narcotic Antagonists
mu Opioid Receptor
Methadone
Secondary Prevention
Pharmaceutical Preparations
Toxicology
Self Report
Counseling
Primary Health Care
Referral and Consultation
Injections

Keywords

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

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

Cite this

Opioid treatment at release from jail using extended-release naltrexone : A pilot proof-of-concept randomized effectiveness trial. / Lee, Joshua; Mcdonald, Ryan; Grossman, Ellie; Mcneely, Jennifer; Laska, Eugene; Rotrosen, John; Gourevitch, Marc.

In: Addiction, Vol. 110, No. 6, 01.06.2015, p. 1008-1014.

Research output: Contribution to journalArticle

Lee, Joshua ; Mcdonald, Ryan ; Grossman, Ellie ; Mcneely, Jennifer ; Laska, Eugene ; Rotrosen, John ; Gourevitch, Marc. / Opioid treatment at release from jail using extended-release naltrexone : A pilot proof-of-concept randomized effectiveness trial. In: Addiction. 2015 ; Vol. 110, No. 6. pp. 1008-1014.
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