Megan M Kelly1, Erin Reilly2, Timothy Quiñones3, Nitigna Desai4, Robert Rosenheck5. 1. VISN 1 VA New England Mental Illness Research, Education, and Clinical Center, USA; Social and Community Reintegration Research Program, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA; Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA; University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA. Electronic address: Megan.Kelly1@va.gov. 2. Social and Community Reintegration Research Program, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA; Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA. 3. Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA. 4. VISN 1 VA New England Mental Illness Research, Education, and Clinical Center, USA; Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA; University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA; Boston University School of Medicine,72 E. Concord Street, Boston, MA 02118, USA. 5. VISN 1 VA New England Mental Illness Research, Education, and Clinical Center, USA; VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Yale University School of Medicine,333 Cedar Street, New Haven, CT 06510, USA.
Abstract
BACKGROUND: Long acting intramuscular (IM) naltrexone is an effective treatment for opioid use disorder (OUD), but rates and correlates of its use have not been studied. METHODS: National administrative from the Veterans Health Administration (VHA) from Fiscal Year 2012 identified only 16 VHA facilities that prescribed IM naltrexone to 5 or more veterans diagnosed with OUD. Data from these facilities were used to identify sociodemographic, diagnostic, and service use characteristics, including use of psychotropic medication, that were characteristic of veterans who filled prescriptions for IM naltrexone. This was in comparison to users of opiate agonist treatments (methadone or buprenorphine) or veterans with no pharmacologic treatment for OUD. Comparisons were made using both bi-variate analyses and multivariable logistic regression. RESULTS: Only 179 of 16,402 veterans with OUD (1%) at these 16 facilities filled a prescription for IM naltrexone and only 256 of 99,394 (0.26%) nationally. These veterans were characterized by past homelessness, co-morbid alcohol use disorder, multiple psychiatric disorders, and a greater likelihood of psychiatric hospitalization, as well as mental health outpatient and antidepressant medication use. CONCLUSIONS: IM naltrexone is rarely used for OUD and is primarily used for patients with multiple co-morbidities, especially alcohol use disorder and serious mental illness. The use of this treatment illustrates many of the principles identified by the emerging focus on multi-morbidity as a critical feature of clinical practice.
BACKGROUND: Long acting intramuscular (IM) naltrexone is an effective treatment for opioid use disorder (OUD), but rates and correlates of its use have not been studied. METHODS: National administrative from the Veterans Health Administration (VHA) from Fiscal Year 2012 identified only 16 VHA facilities that prescribed IM naltrexone to 5 or more veterans diagnosed with OUD. Data from these facilities were used to identify sociodemographic, diagnostic, and service use characteristics, including use of psychotropic medication, that were characteristic of veterans who filled prescriptions for IM naltrexone. This was in comparison to users of opiate agonist treatments (methadone or buprenorphine) or veterans with no pharmacologic treatment for OUD. Comparisons were made using both bi-variate analyses and multivariable logistic regression. RESULTS: Only 179 of 16,402 veterans with OUD (1%) at these 16 facilities filled a prescription for IM naltrexone and only 256 of 99,394 (0.26%) nationally. These veterans were characterized by past homelessness, co-morbid alcohol use disorder, multiple psychiatric disorders, and a greater likelihood of psychiatric hospitalization, as well as mental health outpatient and antidepressant medication use. CONCLUSIONS: IM naltrexone is rarely used for OUD and is primarily used for patients with multiple co-morbidities, especially alcohol use disorder and serious mental illness. The use of this treatment illustrates many of the principles identified by the emerging focus on multi-morbidity as a critical feature of clinical practice.
Authors: Madeline C Frost; Julie E Richards; John R Blosnich; Eric J Hawkins; Judith I Tsui; E Jennifer Edelman; Emily C Williams Journal: Drug Alcohol Depend Date: 2022-06-03 Impact factor: 4.852
Authors: Rachel French; Matthew D McHugh; Linda H Aiken; Peggy Compton; Salimah H Meghani; J Margo Brooks Carthon Journal: Ann Surg Open Date: 2022-07-22