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Multicenter Study
. 2018 Feb:85:49-55.
doi: 10.1016/j.jsat.2017.04.016. Epub 2017 Apr 23.

Relapse to opioid use disorder after inpatient treatment: Protective effect of injection naltrexone

Edward V Nunes  1 , Michael Gordon  2 , Peter D Friedmann  3 , Marc J Fishman  4 , Joshua D Lee  5 , Donna T Chen  6 , Mei Chen Hu  7 , Tamara Y Boney  8 , Donna Wilson  9 , Charles P O'Brien  10
Affiliations
Multicenter Study

Relapse to opioid use disorder after inpatient treatment: Protective effect of injection naltrexone

Edward V Nunes et al. J Subst Abuse Treat. 2018 Feb.

Abstract

Background: Opioid use disorder is often treated with short term hospitalization and medically supervised withdrawal from opioids followed by counseling alone without medication assisted treatment (MAT). More evidence is needed to confirm the expectation that the rate of relapse would be high after short term inpatient treatment and withdrawal from opioids without follow-up MAT.

Objective/methods: To examine relapse to opioid use disorder in a randomized, multi-site effectiveness trial of extended-release injection naltrexone (XR-NTX) vs community-based treatment as usual (TAU) without medication, as a function of the type of clinical service where treatment was initiated-short-term inpatient (N=59), long-term inpatient (N=48), or outpatient (N=201). Inpatients typically were admitted to treatment actively using opioids and had completed withdrawal from opioids before study entry. Outpatients typically presented already abstinent for varying periods of time.

Results: One month after randomization, relapse rates on TAU by setting were: short-term inpatient: 63%; long term inpatient: 14%; outpatient: 28%. On XR-NTX relapse rates after one month were low (<12%) across all three settings. At the end of the 6 month trial, relapse rates on TAU were high across all treatment-initiation settings (short term inpatient 77%; long term inpatient 59%; outpatient 61%), while XR-NTX exerted a modest protective effect against relapse across settings (short term inpatient: 59%; long term inpatient 46%; outpatient 38%).

Conclusions: Short term inpatient treatment is associated with a high rate of relapse among patients with opioid use disorder. These findings support the recommendation that medically supervised withdrawal from opioids should be followed by medication assisted treatment.

Keywords: Detoxification; Injection naltrexone; Inpatient; Medically supervised withdrawal; Medication assisted treatment; Opioid use disorder; Relapse; Residential.

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Figures

Figure 1
Figure 1
Survival curves for time to relapse comparing treatment as usual (TAU) to injection naltrexone (XR-NTX + TAU) across three settings in which patients initiated treatment: short-term inpatient (top panel), long-term inpatient (middle panel), outpatient (bottom panel).
See this image and copyright information in PMC

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