Mohammad Sibai1, Kaitlyn Mishlen2, Edward V Nunes2,3, Frances R Levin2,3, John J Mariani2,3, Adam Bisaga2,3. 1. Department of Psychology, University of Detroit Mercy , Detroit, MI, USA. 2. Division on Substance Use Disorders New York State Psychiatric Institute , New York, NY, USA. 3. Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons , New York, NY, USA.
Abstract
BACKGROUND: Extended-release (XR) naltrexone can prevent relapse to opioid use disorder following detoxification. However, one of the barriers to initiating XR-naltrexone is the recommendation for a 7-10-day period of abstinence from opioids prior to the first dose. OBJECTIVES: The current study evaluated the feasibility of an XR-naltrexone induction protocol that can be implemented over 1 week in the outpatient clinic. METHODS: Participants (N = 44) were seen in the clinic daily. On Day 1, after abstaining from opioids for at least 12 h, they received buprenorphine 6-8 mg. Adjunctive medications (clonidine, clonazepam, zolpidem, trazodone, and prochlorperazine) were dispensed on Days 2-5, while ascending oral doses of naltrexone were given on Days 3-5 starting with 1 mg dose. An injection of XR-naltrexone was given on Day 5, 1 h after receiving and tolerating naltrexone 24 mg. RESULTS: Of the 44 participants (38 males), 35 (80%) were heroin users and 9 (20%) used prescription opioids. A total of 26 participants (59%) completed the induction and received their first injection of XR-naltrexone. XR-naltrexone was initiated in 54% (19/35) of heroin users and 78% (7/9) of prescription opioid users. CONCLUSION: The results support the feasibility of a week-long outpatient induction onto XR-naltrexone with ascending doses of naltrexone and standing doses of adjunctive medications. By circumventing the need for a protracted period of abstinence and mitigating the severity of withdrawal symptoms experienced during naltrexone titration, this strategy has the potential to increase patient acceptability and access to relapse prevention treatment with XR-naltrexone.
BACKGROUND: Extended-release (XR) naltrexone can prevent relapse to opioid use disorder following detoxification. However, one of the barriers to initiating XR-naltrexone is the recommendation for a 7-10-day period of abstinence from opioids prior to the first dose. OBJECTIVES: The current study evaluated the feasibility of an XR-naltrexone induction protocol that can be implemented over 1 week in the outpatient clinic. METHODS:Participants (N = 44) were seen in the clinic daily. On Day 1, after abstaining from opioids for at least 12 h, they received buprenorphine 6-8 mg. Adjunctive medications (clonidine, clonazepam, zolpidem, trazodone, and prochlorperazine) were dispensed on Days 2-5, while ascending oral doses of naltrexone were given on Days 3-5 starting with 1 mg dose. An injection of XR-naltrexone was given on Day 5, 1 h after receiving and tolerating naltrexone 24 mg. RESULTS: Of the 44 participants (38 males), 35 (80%) were heroin users and 9 (20%) used prescription opioids. A total of 26 participants (59%) completed the induction and received their first injection of XR-naltrexone. XR-naltrexone was initiated in 54% (19/35) of heroin users and 78% (7/9) of prescription opioid users. CONCLUSION: The results support the feasibility of a week-long outpatient induction onto XR-naltrexone with ascending doses of naltrexone and standing doses of adjunctive medications. By circumventing the need for a protracted period of abstinence and mitigating the severity of withdrawal symptoms experienced during naltrexone titration, this strategy has the potential to increase patient acceptability and access to relapse prevention treatment with XR-naltrexone.
Entities:
Keywords:
Opioid use disorder; XR-naltrexone; detoxification; heroin; opioid; outpatient
Authors: Maria Sullivan; Adam Bisaga; Martina Pavlicova; C Jean Choi; Kaitlyn Mishlen; Kenneth M Carpenter; Frances R Levin; Elias Dakwar; John J Mariani; Edward V Nunes Journal: Am J Psychiatry Date: 2017-01-10 Impact factor: 18.112
Authors: Paolo Mannelli; Li-Tzy Wu; Kathleen S Peindl; Marvin S Swartz; George E Woody Journal: Drug Alcohol Depend Date: 2014-02-15 Impact factor: 4.492
Authors: Evgeny Krupitsky; Edward V Nunes; Walter Ling; Ari Illeperuma; David R Gastfriend; Bernard L Silverman Journal: Lancet Date: 2011-04-30 Impact factor: 79.321
Authors: Joshua D Lee; Edward V Nunes; Patricia Novo; Ken Bachrach; Genie L Bailey; Snehal Bhatt; Sarah Farkas; Marc Fishman; Phoebe Gauthier; Candace C Hodgkins; Jacquie King; Robert Lindblad; David Liu; Abigail G Matthews; Jeanine May; K Michelle Peavy; Stephen Ross; Dagmar Salazar; Paul Schkolnik; Dikla Shmueli-Blumberg; Don Stablein; Geetha Subramaniam; John Rotrosen Journal: Lancet Date: 2017-11-14 Impact factor: 79.321
Authors: Maria A Sullivan; Adam Bisaga; Martina Pavlicova; Kenneth M Carpenter; C Jean Choi; Kaitlyn Mishlen; Frances R Levin; John J Mariani; Edward V Nunes Journal: Am J Psychiatry Date: 2018-10-19 Impact factor: 18.112
Authors: Marc Fishman; Kevin Wenzel; Jennifer Scodes; Martina Pavlicova; Joshua D Lee; John Rotrosen; Edward Nunes Journal: J Adolesc Health Date: 2020-08-29 Impact factor: 5.012
Authors: Matisyahu Shulman; Mei-Chen Hu; Maria A Sullivan; Sarah C Akerman; James Fratantonio; Vincent Barbieri; Edward V Nunes; Adam Bisaga Journal: Drug Alcohol Depend Date: 2022-02-02 Impact factor: 4.492
Authors: Frances R Levin; John J Mariani; Martina Pavlicova; C Jean Choi; Cale Basaraba; Amy L Mahony; Daniel J Brooks; Nasir Naqvi; Adam Bisaga Journal: Drug Alcohol Depend Date: 2021-01-05 Impact factor: 4.492
Authors: Ryan R Cook; Randy Torralva; Caroline King; Paula J Lum; Hansel Tookes; Canyon Foot; Pamela Vergara-Rodriguez; Allan Rodriguez; Laura Fanucchi; Gregory M Lucas; Elizabeth N Waddell; P Todd Korthuis Journal: Drug Alcohol Depend Date: 2021-09-20 Impact factor: 4.492