Employment-based reinforcement of adherence to an FDA approved extended release formulation of naltrexone in opioid-dependent adults: A randomized controlled trial

Research output: Contribution to journalArticle

Abstract

Background: Naltrexone provides excellent opioid blockade, but its clinical utility is limited because opioid-dependent patients typically refuse it. An injectable suspension of naltrexone for extended release (XR-NTX) was recently approved by the FDA for treatment of opioid dependence. XR-NTX treatment may require concurrent behavioral intervention to maximize adherence and effectiveness, thus we sought to evaluate employment-based reinforcement as a method of improving adherence to XR-NTX in opiate dependent adults. Methods: Opioid-dependent adults (n = 38) were detoxified and inducted onto oral naltrexone, then randomly assigned to contingency or prescription conditions. Participants received up to six doses of XR-NTX at four-week intervals. All participants could earn vouchers for attendance and performance at a therapeutic workplace. Contingency participants were required to accept XR-NTX injections to access the workplace and earn vouchers. Prescription participants could earn vouchers independent of their acceptance of XR-NTX injections. Results: Contingency participants accepted significantly more naltrexone injections than prescription participants (87% versus 52%, p= .002), and were more likely to accept all injections (74% versus 26%, p= .004). Participants in the two conditions provided similar percentages of samples negative for opiates (72% versus 65%) and for cocaine (58% versus 54%). Opiate positivity was significantly more likely when samples were also cocaine positive, independent of naltrexone blockade (p= .002). Conclusions: Long-term adherence to XR-NTX in unemployed opiate dependent adults is low under usual care conditions. Employment-based reinforcement can maintain adherence to XR-NTX. Ongoing cocaine use appears to interfere with the clinical effectiveness of XR-NTX on opiate use.

Original languageEnglish (US)
Pages (from-to)48-54
Number of pages7
JournalDrug and Alcohol Dependence
Volume120
Issue number1-3
DOIs
StatePublished - Jan 1 2012

Fingerprint

Opiate Alkaloids
Naltrexone
Opioid Analgesics
Reinforcement
Randomized Controlled Trials
Injections
Cocaine
Prescriptions
Workplace
Suspensions
Therapeutics

Keywords

  • Contingency management
  • Extended-release naltrexone
  • Heroin
  • Incentives
  • Opioid pharmacotherapy
  • Therapeutic workplace

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Toxicology
  • Pharmacology
  • Pharmacology (medical)

Cite this

@article{896412e2b0af4643867fbefc3d54a11b,
title = "Employment-based reinforcement of adherence to an FDA approved extended release formulation of naltrexone in opioid-dependent adults: A randomized controlled trial",
abstract = "Background: Naltrexone provides excellent opioid blockade, but its clinical utility is limited because opioid-dependent patients typically refuse it. An injectable suspension of naltrexone for extended release (XR-NTX) was recently approved by the FDA for treatment of opioid dependence. XR-NTX treatment may require concurrent behavioral intervention to maximize adherence and effectiveness, thus we sought to evaluate employment-based reinforcement as a method of improving adherence to XR-NTX in opiate dependent adults. Methods: Opioid-dependent adults (n = 38) were detoxified and inducted onto oral naltrexone, then randomly assigned to contingency or prescription conditions. Participants received up to six doses of XR-NTX at four-week intervals. All participants could earn vouchers for attendance and performance at a therapeutic workplace. Contingency participants were required to accept XR-NTX injections to access the workplace and earn vouchers. Prescription participants could earn vouchers independent of their acceptance of XR-NTX injections. Results: Contingency participants accepted significantly more naltrexone injections than prescription participants (87{\%} versus 52{\%}, p= .002), and were more likely to accept all injections (74{\%} versus 26{\%}, p= .004). Participants in the two conditions provided similar percentages of samples negative for opiates (72{\%} versus 65{\%}) and for cocaine (58{\%} versus 54{\%}). Opiate positivity was significantly more likely when samples were also cocaine positive, independent of naltrexone blockade (p= .002). Conclusions: Long-term adherence to XR-NTX in unemployed opiate dependent adults is low under usual care conditions. Employment-based reinforcement can maintain adherence to XR-NTX. Ongoing cocaine use appears to interfere with the clinical effectiveness of XR-NTX on opiate use.",
keywords = "Contingency management, Extended-release naltrexone, Heroin, Incentives, Opioid pharmacotherapy, Therapeutic workplace",
author = "Anthony DeFulio and Everly, {Jeffrey J.} and Leoutsakos, {Jeannie-Marie S} and Annie Umbricht and Fingerhood, {Michael I} and George Bigelow and Kenneth Silverman",
year = "2012",
month = "1",
day = "1",
doi = "10.1016/j.drugalcdep.2011.06.023",
language = "English (US)",
volume = "120",
pages = "48--54",
journal = "Drug and Alcohol Dependence",
issn = "0376-8716",
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TY - JOUR

T1 - Employment-based reinforcement of adherence to an FDA approved extended release formulation of naltrexone in opioid-dependent adults

T2 - A randomized controlled trial

AU - DeFulio, Anthony

AU - Everly, Jeffrey J.

AU - Leoutsakos, Jeannie-Marie S

AU - Umbricht, Annie

AU - Fingerhood, Michael I

AU - Bigelow, George

AU - Silverman, Kenneth

PY - 2012/1/1

Y1 - 2012/1/1

N2 - Background: Naltrexone provides excellent opioid blockade, but its clinical utility is limited because opioid-dependent patients typically refuse it. An injectable suspension of naltrexone for extended release (XR-NTX) was recently approved by the FDA for treatment of opioid dependence. XR-NTX treatment may require concurrent behavioral intervention to maximize adherence and effectiveness, thus we sought to evaluate employment-based reinforcement as a method of improving adherence to XR-NTX in opiate dependent adults. Methods: Opioid-dependent adults (n = 38) were detoxified and inducted onto oral naltrexone, then randomly assigned to contingency or prescription conditions. Participants received up to six doses of XR-NTX at four-week intervals. All participants could earn vouchers for attendance and performance at a therapeutic workplace. Contingency participants were required to accept XR-NTX injections to access the workplace and earn vouchers. Prescription participants could earn vouchers independent of their acceptance of XR-NTX injections. Results: Contingency participants accepted significantly more naltrexone injections than prescription participants (87% versus 52%, p= .002), and were more likely to accept all injections (74% versus 26%, p= .004). Participants in the two conditions provided similar percentages of samples negative for opiates (72% versus 65%) and for cocaine (58% versus 54%). Opiate positivity was significantly more likely when samples were also cocaine positive, independent of naltrexone blockade (p= .002). Conclusions: Long-term adherence to XR-NTX in unemployed opiate dependent adults is low under usual care conditions. Employment-based reinforcement can maintain adherence to XR-NTX. Ongoing cocaine use appears to interfere with the clinical effectiveness of XR-NTX on opiate use.

AB - Background: Naltrexone provides excellent opioid blockade, but its clinical utility is limited because opioid-dependent patients typically refuse it. An injectable suspension of naltrexone for extended release (XR-NTX) was recently approved by the FDA for treatment of opioid dependence. XR-NTX treatment may require concurrent behavioral intervention to maximize adherence and effectiveness, thus we sought to evaluate employment-based reinforcement as a method of improving adherence to XR-NTX in opiate dependent adults. Methods: Opioid-dependent adults (n = 38) were detoxified and inducted onto oral naltrexone, then randomly assigned to contingency or prescription conditions. Participants received up to six doses of XR-NTX at four-week intervals. All participants could earn vouchers for attendance and performance at a therapeutic workplace. Contingency participants were required to accept XR-NTX injections to access the workplace and earn vouchers. Prescription participants could earn vouchers independent of their acceptance of XR-NTX injections. Results: Contingency participants accepted significantly more naltrexone injections than prescription participants (87% versus 52%, p= .002), and were more likely to accept all injections (74% versus 26%, p= .004). Participants in the two conditions provided similar percentages of samples negative for opiates (72% versus 65%) and for cocaine (58% versus 54%). Opiate positivity was significantly more likely when samples were also cocaine positive, independent of naltrexone blockade (p= .002). Conclusions: Long-term adherence to XR-NTX in unemployed opiate dependent adults is low under usual care conditions. Employment-based reinforcement can maintain adherence to XR-NTX. Ongoing cocaine use appears to interfere with the clinical effectiveness of XR-NTX on opiate use.

KW - Contingency management

KW - Extended-release naltrexone

KW - Heroin

KW - Incentives

KW - Opioid pharmacotherapy

KW - Therapeutic workplace

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