Extended-Release Naltrexone for Alcohol Dependence: Feasibility in Primary- Care Settings

Pharmacotherapies for alcohol use disorders are seldom prescribed in primary-care practices, despite the fact that patients with these disorders are more likely to be seen in general medical settings than in specialty care. This case series evaluated the feasibility of implementing a combination of extended-release naltrexone (XR-NTX) and medical management (physician-led counseling with a focus on medication adherence and abstinence) in a primary-care setting. The sample included 72 alcohol-dependent patients recruited through advertising and from other clinics who presented to 2 urban hospital primary-care clinics for treatment.

• Ninety percent of patients (n=65) received 1 planned XR-NTX injection, 75% (n=49) received a second planned injection, and 62% (n=40) received a third planned injection.

• Sixteen of the 65 patients who initiated treatment were lost to follow-up. An additional 5 patients discontinued treatment due to side effects, and 4 patients reported no treatment effect and continued heavy drinking.

• Two serious adverse events occurred (a severe injection-site reaction and an unexpected pregnancy).

• Mean drinks per day decreased from 5.4 to 3.4 in intention-to-treat analyses; however, among the 40 patients who received all 3 injections, mean drinks per day decreased from 4.1 to 0.5.

Comments:

Injectable pharmacotherapies for addiction are designed to address concerns about adherence. This study suggests that the combination of XR-NTX and medical management to treat alcohol-dependent patients in primary care is feasible. Larger controlled trials including patients recruited primarily from general medical settings and powered to detect changes in drinking outcomes over time should be conducted to lend further support for this treatment modality in primary care.

Jeanette M. Tetrault, MD

Reference:

Lee JD, Grossman E, Di- Rocco D, et al. Extended-release naltrexone for treatment of alcohol dependence in primary care. J Subst Abuse Treat. 2010;39(1):14–21.