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

ABSTRACT

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.

KEYWORDS:

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

Acknowledgments

We would like to thank Eva Vasquez and Diane Herbeck for their contributions to UCLA data collection. We also appreciate the comments of Diane Herbeck and Kris Lanagabeer on the article. Additionally, we would like to acknowledge Yanira Lima, Holly McCravey, Valerie Sifuentes, and Tammi De Masters from the Division of Substance Abuse Prevention and Control for their assistance to the project.

Author contributions

Drs. Crèvecoeur-MacPhail, Barger, and Rawson and Mr. Viernes and Mr. Sugita contributed to the design of the demonstration project. Mss. Cousins, Denering, and Weimann as well as Drs. Kim, Crèvecoeur-MacPhail, and Rawson managed the evaluation component of this demonstration project and data collection as well as conducted the data analysis. All authors contributed to the writing of this article.

Funding

The evaluation component of this demonstration project was supported by contract number PH-000179 from the Los Angeles County Department of Public Health (DPH) Substance Abuse Prevention and Control. No part of this demonstration project or evaluation was funded by Alkermes who manufactures extended-release naltrexone (“Vivitrol”). This project was funded solely by the Los Angeles County Department of Public Health Substance Abuse Prevention and Control. Therefore, the authors have no conflicts of interest to report.