Maintenance on Extended-Release Naltrexone is Associated With Reduced Injection Opioid Use Among Justice-Involved Persons With Opioid Use Disorder

Author: Audun Lier Nikhil Seval Angela Di Paola Brent Vander Wyk Sandra Springer

Theme: Clinical Research Year: 2022

Opioid use disorder (OUD) and injection drug use (IDU) place justice-involved individuals at
increased risk for acquiring or transmitting HIV or hepatitis C virus (HCV). Methadone and
buprenorphine have been associated with reduced opioid IDU, however the effect of extendedrelease naltrexone (XR-NTX) on this behavior is incompletely studied.

Injection opioid use and shared injection equipment behavior was examined from a completed
double-blind placebo-controlled trial of XR-NTX among 88 justice-involved participants with HIV and
OUD. Changes in participants’ self-reported daily injection opioid use and shared injection
equipment was evaluated pre-incarceration, during incarceration and monthly post-release for 6
months. Differences in time to first opioid injection post release was also assessed. Intention to treat
and ‘as treated’ (high treatment versus low treatment) analyses were performed.

Fifty eight of 88 (65.9%) participants self-reported injection of opioids pre-incarceration and 26
(29.5%) reported sharing injection equipment. Fifty-four (61.4%) participants had an HIV RNA below
200 copies/mL and 62 (70.5%) were baseline HCV antibody positive. Participants in the high
treatment group had significantly lower mean proportion of days injecting opioids (13.8% high
treatment versus 22.8% low treatment, p=0.02) by month 1 which persisted up to 5 months post
release (0% high treatment vs 24.3% low treatment, p<0.001) and experienced a longer time to first
opioid injection post-release (143.8 days high treatment vs 67.4 days low treatment, p<0.001).

Retention on XR-NTX is associated with reduced intravenous opioid use in justice-involved persons,
which has important implications for reducing transmission of HIV and HCV.

Disclosure of Interest Statement:

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