Extended-Release Naltrexone May Reduce Opioid Use at Jail Release

Relapse to drug use is common when people with opioid use disorder are released from jail. This open-label effectiveness trial randomized 34 such inmates not seeking agonist treatment to extended-release naltrexone (XR-NTX) within a week prior to release, versus no medication. The medication arm received a second injection 4 weeks after release, and all participants received brief motivational enhancement counseling and referrals to community treatment. Of the 17 randomized to XR-NTX, 15 received the pre-release injection and 12 (75%) received the second injection.

• By week 4, the rate of opioid relapse, defined as ≥ 10 days of self-reported opioid use and urine toxicology, was lower in the XR-NTX group (38%) than the counseling and referral group (88%). Also, fewer XR-NTX urine samples were positive for opioids (41% versus 71%).
• By week 8, the rate of opioid relapse remained lower in the XR-NTX group (50%) than the counseling and referral group (93%), and fewer XR-NTX urine samples were positive for opioids (41% versus 76%).
• There were no differences in rates of intravenous drug use, cocaine use, re-incarceration, or overdose.

Comments:

Though promising, it is uncertain whether these findings extrapolate to inmates with opioid use disorder who are not research volunteers and to those who prefer agonist therapy. Furthermore, while reduction in opioid use is an important health outcome, it remains unclear whether pre-release XR-NTX will reduce crime, recidivism, re-arrest, re-incarceration, and overall costs – outcomes that matter most to correctional agencies and policymakers. Pre-release XR-NTX might prove to be a useful tool to facilitate the community reentry of some inmates, but proponents should be cautious about overselling these preliminary data and the premature adoption of this strategy.

Peter D. Friedmann, MD

Reference:

Lee JD, McDonald R, Grossman E, et al. Opioid treatment at release from jail using extended-release naltrexone: a pilot proof-of-concept randomized effectiveness trial. Addiction. 2015;110(6):1008–1014.