Extended-release injectable naltrexone for opioid use disorder: a systematic review
Brantley P Jarvis1, August F Holtyn1, Shrinidhi Subramaniam1
1Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Addiction (Abingdon, England)
|February 4, 2018
Summary
Extended-release naltrexone (XR-NTX) shows limited induction success and adherence in opioid use disorder treatment. While XR-NTX may reduce opioid use, premature discontinuation hinders its clinical utility.
Area of Science:
- Pharmacology
- Addiction Medicine
- Public Health
Background:
- Opioid use disorder (OUD) is a significant public health crisis.
- Extended-release naltrexone (XR-NTX) is a once-monthly injectable medication for OUD.
- Understanding XR-NTX's effectiveness and adherence is crucial for OUD treatment.
Purpose of the Study:
- To systematically review the literature on XR-NTX for OUD treatment.
- To assess XR-NTX induction success, adherence rates, and impact on opioid use.
- To examine factors influencing these outcomes and overdose rates.
Main Methods:
- Systematic literature search of PubMed and Google Scholar (2006-2017).
- Inclusion of peer-reviewed studies on individuals seeking OUD treatment with XR-NTX.
- Analysis of 34 identified studies, pooling data for key outcomes.
Main Results:
- XR-NTX induction success was lower when detoxification was required (62.6%) versus already completed (85.0%).
- Adherence to all injections was 44.2%, with higher rates in prospective studies (46.7%) than retrospective (10.5%).
- XR-NTX reduced opioid use in specific populations (criminal justice, pre-release inmates) and compared to placebo in some contexts, with variable efficacy against buprenorphine.
Conclusions:
- Many patients do not initiate or complete XR-NTX treatment, limiting its clinical utility.
- XR-NTX shows potential for reducing opioid use, but experimental evidence is limited.
- Further research is needed to optimize XR-NTX initiation and adherence for OUD management.
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