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Surmounting Withdrawal to Initiate Fast Treatment with Naltrexone (SWIFT): A stepped wedge hybrid type 1

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A rapid induction method for extended-release injectable naltrexone (XR-NTX) shows promise for treating opioid use disorder (OUD). This faster approach may improve access to essential OUD pharmacotherapy.

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Area of Science:

  • Addiction medicine
  • Pharmacotherapy implementation
  • Public health

Background:

  • Extended-release injectable naltrexone (XR-NTX) is effective for opioid use disorder (OUD).
  • Standard XR-NTX initiation requires lengthy inpatient stays (10-15 days) with opioid tapers and washout periods.
  • A rapid induction approach using low-dose oral naltrexone and non-opioid medications was developed to shorten admission times.

Purpose of the Study:

  • To compare the effectiveness of a standard procedure (SP) versus a rapid procedure (RP) for XR-NTX initiation.
  • To evaluate the implementation process of the rapid procedure in community addiction treatment units.
  • To determine if RP is non-inferior to SP in initiating XR-NTX and results in shorter inpatient stays.

Main Methods:

  • The CTN-0097 SWIFT study was a hybrid type I effectiveness-implementation trial.
  • Six community inpatient addiction treatment units participated.
  • Sites were randomized to implement either SP or RP in a stepped-wedge design, with participants receiving the procedure active at their admission time.

Main Results:

  • The study hypothesized that the rapid procedure (RP) would be non-inferior to the standard procedure (SP) for XR-NTX initiation.
  • A key outcome was a shorter inpatient admission time for the RP group.
  • Superiority of RP over SP was planned for testing if non-inferiority was established.

Conclusions:

  • Successful implementation of a rapid XR-NTX induction could significantly reduce inpatient stays.
  • This approach has the potential to increase access to OUD pharmacotherapy, improving public health outcomes.
  • Understanding implementation facilitators and barriers is crucial for broader adoption of the rapid procedure.