Extended-release naltrexone for opioid use disorder started during or following incarceration

A western Massachusetts county jail began initiating extended-release naltrexone (XR-NTX) prior to release from incarceration and linking participants to community treatment providers upon release. Program barriers prevented the start of XR-NTX prior to release for a subset. Methods: This report consists of the initial 67 jail releasees with opioid dependence, 47 who received XR-NTX before release, and 20 after release. Utility of the program was assessed by determining medication addiction treatment (MAT) retention rates at 4, 8, and 24 weeks. Results: Forty-seven commenced XR-NTX approximately 7 days prior to release, and 20 were referred to commence XR-NTX at outpatient treatment centers. Rate of retention at week 4 was higher in group with treatment initiation prior to release as compared to those started in community: week 4:55% (24 XR-NTX + 2 agonist MAT out of 47) versus 25% (4 XR-NTX + 1 agonist MAT out of 20) (p = 0.03); week 8:36% (13 XR-NTX + 4 agonist) versus 25% (3 XR-NTX + 2 agonist) (p = 0.41); week 24: 21% (6 XR-NTX + 4 agonist) versus 15% (1 XR-NTX + 2 agonist) (p = 0.74). Three patients died, all in the pre-release group, all from overdose at 3-5 months after release and 2.5 or more months after stopping XR-NTX, compared to none of 20 in community group (p = 0.55). Limitations include that cohorts were non-random and observational; substance use could not be consistently determined; and overdose deaths in MA occurred partly in clusters, limiting historical comparisons. Conclusions: Receiving XR-NTX prior to jail release for opioid use disorder appears to increase the treatment retention rate as compared to commencing after release. The treatment attrition and striking rate of overdose deaths are concerning, and support expanded availability of opioid agonist treatments prior to release and other evidence-based supports and retention strategies in the community. (C) 2017 Elsevier Inc. All rights reserved.