A demonstration project implementing extended-release naltrexone in Los Angeles County

作者：Cousins Sarah J^*; Denering Loretta; Crevecoeur MacPhail Desiree; Viernes John; Sugita Wayne; Barger James; Kim Tina; Weimann Stefanie; Rawson Richard A

来源：Substance Abuse, 2016, 37(1): 54-62.

DOI：10.1080/08897077.2015.1052868

• naltrexone
• medication-assisted treatment
• XR-NTX
• implementation
• opioid use disorder
• Alcohol use disorder
• evidence-based practice

Background: Extended-released naltrexone (XR-NTX) is a Food and Drug Administration (FDA)-approved medication associated with higher rates of abstinence, reduced cravings, and delayed relapse to use. However, there is a dearth of literature on real-world implementation of XR-NTX. The Los Angeles County Department of Public Health, in collaboration with UCLA Integrated Substance Abuse Programs, developed a demonstration project to inc`rease access to XR-NTX. This article describes that project, along with data on the expansion of XR-NTX service delivery and patient uptake. Methods: A secondary descriptive data analysis of demographics, substance use history, current substance use behaviors, health-related variables, and dosing records was conducted on 609 patients who received XR-NTX from Los Angeles County substance use disorder (SUD) treatment facilities from April 2010 through July 2013. A geographic information system approach mapped the distribution of XR-NTX-referring agencies across Los Angeles County. Results: Of the 609 records analyzed, a majority of patients (64%) obtained more than 1 dose of XR-NTX. Most XR-NTX patients reported alcohol use disorder (71.9%; n = 438). Compared with the general Los Angeles County substance use disorder patients, XR-NTX recipients reported more severe substance use histories. Finally, XR-NTX was accessed by providers in 6 of the 8 Service Planning Areas of Los Angeles County. Conclusions: These findings reflect a higher XR-NTX cessation rate and a lower average number of doses, in contrast to similar demonstration projects in community settings with patients on parole or probation. However, this study shows that it is feasible to engage treatment providers in the use XR-NTX among their patients with alcohol or opioid use disorders. Several implications for future research and implementation are discussed.

• 出版日期2016-1-2