Monthly Injectable Naltrexone for Opioid Use Disorder

Peter M. Yellowlees, MBBS, MD


February 27, 2019

This transcript has been edited for clarity.

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

Oral naltrexone has shown limited effectiveness for treatment of opioid use disorder due to poor adherence, whereas long-acting injection naltrexone (XR-naltrexone) administered monthly has been shown to be superior to placebo in reducing opioid use over 6 months of treatment.

A team of investigatorsfrom Columbia University in New York has performed an open-label trial comparing the outcomes of patients with opioid use disorder treated with XR-naltrexone or oral naltrexone in combination with behavioral therapy.[1] A total of 60 opioid-dependent adults completed inpatient opioid withdrawal and were transitioned to oral naltrexone.

They were stratified by severity of opioid use and randomly assigned to continue treatment with oral naltrexone (n = 32) or XR-naltrexone (n = 28) for 24 weeks. All participants received weekly behavioral therapy to support treatment and adherence to naltrexone. The researchers found that patients receiving XR-naltrexone had twice the rate of treatment retention at 6 months compared with those taking oral naltrexone.

Why is this small, open-label study important? The results support the use of XR-naltrexone combined with behavioral therapy as a more effective treatment than oral naltrexone and behavioral therapy for patients seeking opioid withdrawal and non-agonist treatment.

Most clinicians will be surprised by the size of the difference in the patient outcomes. Although this would seem to be a good reason to change practice, it is worth noting that XR-naltrexone is up to 20 times more expensive than oral naltrexone; therefore, its availability for our patients will likely depend on their insurance status. I suggest that you quote this text when arguing for your prior authorizations or to have exorbitant drug prices reduced.

Thank you for listening to this Medscape Psychiatry Minute. Do continue to enjoy your practice.

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