Correlates of post-hospitalization naltrexone adherence for alcohol use disorder

Abstract

Introduction: Hospitalizations present an opportunity to initiate naltrexone for patients with alcohol use disorder (AUD). Understanding factors associated with post-hospitalization adherence could inform practice.

Methods: This study is a secondary analysis of a clinical trial in which patients with AUD were randomized to oral (PO) versus long-acting injectable (LAI) naltrexone at hospital discharge. The outcome of this secondary analysis was naltrexone adherence 3 months after discharge, defined as receipt of at least 2 out of 3 monthly injections or the equivalent days of self-reported PO medication use (60 out of 90). We used baseline socio-demographics, substance use history, health status, healthcare utilization, and randomization arm to construct multivariable logistic regression models to identify correlates of adherence.

Results: We evaluated patients who initiated naltrexone treatment, 124 randomized to PO and 120 to LAI (overall mean age 49 years, 80 % male, 51 % Black, 47 % unhoused, and 91 % with severe AUD). At 3 months, 50 % of patients were adherent. LAI naltrexone (aOR 3.88; 95 % CI 2.17-7.13), recent office visit (aOR 2.01; 95 % CI 1.10-3.72), and age (aOR per 10-year increase 1.37; 95 % CI 1.02-1.88) were associated with increased odds of adherence. Unhoused status (aOR 0.54; 95 % CI 0.30-0.98) and cocaine use (aOR 0.35; 95 % CI 0.17-0.71) were associated with decreased odds of adherence.

Conclusions: LAI naltrexone for AUD at hospital discharge was associated with better adherence at 3 months vs PO. Access to LAI naltrexone and targeted interventions for patients with cocaine use or who are unhoused hold potential to improve naltrexone adherence.

Keywords: Adherence; Alcohol use disorder; Hospitalization; Injectable; Naltrexone; Oral.