Theme: Models of Care Year: 2019
Background:
Opioid use disorder (OUD) affects 2 million persons worldwide. 50% may have HCV infection.
Treatment with methadone and suboxone, are well-studied options in PWIDs. XR-NTX is less
studied, especially in young PWIDs who recently had medically supervised withdrawal. We report a
model of care with concurrent co-located treatment of OUD, using XR-NTX, and HCV in young
PWIDs.
Description of model of care/intervention:
Persons age 18-35 were identified at acute hospitals and sober living homes with OUD and HCV.
Informed consent was obtained from patients to be treated concurrently with XR-NTX and HCV
treatment. An APN and addiction certified social worker performed co-located bi-monthly visits
where medications, medical care and counselling were provided. Weekly telephone encounters
occurred. Transportation barriers were limited by coordination with the state insurance medical
benefit, LogistiCare or Uber. XR-NTX injection adverse effects were documented. Abstinence was
assessed by patient’s account and urine drug screens (UDS). Visual analog scale (VAS) recorded
cravings.
Effectiveness:
2/17 enrollees were ineligible. 29 years was mean age of 15 enrollees. 53% were female. 94% were
non-Hispanic white. 60% (9) received more than one XR-NTX administration. For those on treatment,
UDS were negative 91% of visits for opioids. Patients reported abstinence 88% of the time. VAS
craving scores averaged 17 prior to XR-NTX and 5 by month 3. Despite an average ALT of 93 (range
31-301) no adverse effects on liver or generally were noted in patients receiving XR-NTX. 10/15
(60%) were retained in care. To date, 6/15 have been cured of HCV. To be updated at the
presentation.
Conclusion and next steps:
XR-NTX is a useful treatment in young persons who had recent withdrawal management as part of a
multidisciplinary integrated model of care to treat HCV as evidenced by abstinence, opioid cravings
and ongoing engagement in care.
Disclosure of Interest Statement:
Dr. Nahass has received grant funding from AbbVie, Alkermes, Merck, Gilead, ViiV; has conducted
speaking and/or advisory activities for Merck, AbbVie, Gilead. Pharmaceutical grant from AbbVie
and Alkermes was received in the development of this study.
Kathleen Seneca has conducted speaking activities for Merck and AbbVie.