Extended Release Naltrexone for Alcohol Use Disorders: Quasi-Experimental Effects on Mortality and Subsequent Detoxification Episodes

Background Utilization of extended release naltrexone (XRN) for alcohol use disorders (AUDs) in the U.S. Veterans Health Administration (VHA) has been limited, perhaps due to high cost, lack of established superiority over less expensive alternatives including oral naltrexone, and related formulary...

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Published in:Alcoholism, clinical and experimental research clinical and experimental research, 2015-01, Vol.39 (1), p.79-83
Main Authors: Harris, Alex H. S., Bowe, Thomas, Del Re, Aaron C., Finlay, Andrea K., Oliva, Elizabeth, Myrick, Hugh L., Rubinsky, Anna D.
Format: Article
Language:English
Subjects:
Alcohol Dependence
Alcohol Use Disorders
Alcohol-Related Disorders - drug therapy
Alcohol-Related Disorders - mortality
Comorbidity
Delayed-Action Preparations - therapeutic use
Female
Humans
Logistic Models
Male
Medication-Assisted Treatment
Middle Aged
Naltrexone
Naltrexone - therapeutic use
Narcotic Antagonists - therapeutic use
Treatment Outcome
United States - epidemiology
United States Department of Veterans Affairs
Veterans
Veterans Health Administration
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Summary:Background Utilization of extended release naltrexone (XRN) for alcohol use disorders (AUDs) in the U.S. Veterans Health Administration (VHA) has been limited, perhaps due to high cost, lack of established superiority over less expensive alternatives including oral naltrexone, and related formulary restrictions. Despite these barriers, pockets of higher utilization exist in VHA, allowing for the quasi‐experimental examination of the effects of XRN on 1‐year mortality and number of subsequent detoxification episodes among patients with high rates of psychiatric comorbidities and previous psychosocial and pharmacological addiction treatment. Methods Using propensity score‐weighted mixed‐effects logistic regression, 1‐year mortality was compared between patients with AUDs who received XRN in fiscal year 2010 (n = 387) and a random sample of patients with AUDs who did not receive XRN (n = 3,759). Among the subgroup of patients who had at least 1 detoxification episode in the previous year, 1‐year mortality and number of subsequent detoxification episodes were compared between those who did and did not receive XRN. Results Overall, 1‐year mortality for the patients receiving XRN was significantly lower than for the comparison group who did not receive XRN (odds ratio [OR] = 0.30; p 
ISSN:0145-6008
1530-0277
DOI:10.1111/acer.12597