Loading...
Criminal justice clients who are opioid-dependent find it difficult to obtain opioid-replacement therapies and are at heightened risk for relapse. These researchers tested the usefulness in this population of extended-release naltrexone, an effective alternative to opioid replacement therapies, in a multisite, 24-week, open-label trial. The 308 opioid-dependent, community-living ex-prisoners, mostly heroin users with limited use in the previous 30 days, were randomized to usual care alone (relapse-prevention counseling and community support) or usual care plus monthly injections of manufacturer-supplied, extended-release naltrexone.
Naltrexone-treated participants had a longer time to relapse (10 vs. 5 weeks in controls), lower relapse rates (43% vs. 64%), and more biweekly opioid-negative urine samples (74% vs. 56%). The groups did not differ in self-reported use of other drugs or alcohol, in risky behaviors (sexual or injection-drug use), or in re-incarceration. At 78 weeks, group differences in outcomes were no longer seen.
Lee JD et al. Extended-release naltrexone to prevent opioid relapse in ex-prisoners. N Engl J Med 2016 Mar 31; 374:1232. (http://dx.doi.org/10.1056/NEJMoa1505409)
Comment
In this difficult-to-treat population, extended-release naltrexone increased the likelihood of temporary recovery from opioid dependence (i.e., for as long as patients received the medication). The number needed to treat (relapse risk, 5) compares favorably with some of the most effective behavioral health treatments. The regime of monthly injections might allow easier re-integration into the community than would daily opioid replacement. However, the transient nature of the therapeutic effect and the absence of effects on other drug- and alcohol-related outcomes and on re-incarceration suggests that treatment needs to be broader and target other issues besides opioid dependence. Unfortunately, the availability of addiction-targeted psychosocial treatments in this population is limited.