Emergency Department-initiated Injectable Naltrexone Plus Case Management Reduced Alcohol Consumption in Adults With Alcohol Use Disorder

Researchers conducted a prospective, open-label, single-arm study of a monthly injection of extended-release naltrexone plus case management in an urban emergency department (ED) for adult ED patients with alcohol use disorder (AUD). Participants received naltrexone injections at weeks 0, 4, and 8, as well as case management services (i.e., motivational interviewing, transportation and housing assistance, treatment and support group navigation, and advocacy and support). The primary outcome was change in alcohol consumption at 12-week follow-up, compared with baseline. Secondary outcomes included quality of life measures.

• One hundred seventy-nine patients were approached to participate in the study; 32 enrolled.
• Of the enrolled patients, 25 (78 percent) attended all follow-up visits, and 22 (69 percent) continued receiving naltrexone after the study ended.
• Compared with baseline, participants’ mean daily alcohol consumption decreased by 7.5 standard drinks in a day, an 81 percent reduction in alcohol consumption.
• Participants experienced an increase in mean reported quality of life by 1.2 points (on a 7-point scale).

Comments: The ED treats a significant number of patients with AUD, offering an important opportunity to initiate treatment and link patients to ongoing care. There were notable limitations to this feasibility pilot study, including small sample size, use of convenience sampling, and use of a research assistant to perform the intervention, which may limit the generalizability of the results. However, the results suggest that initiation of injectable naltrexone with case management for AUD in the ED is a promising intervention to reduce alcohol consumption, increase treatment engagement, and improve quality of life for patients with AUD.

Elizabeth A. Samuels, MD, MPH, MHS

Reference: Murphy CE 4th, Coralic Z, Wang RC, et al. Extended-release naltrexone and case management for treatment of alcohol use disorder in the emergency department. Ann Emerg Med. 2023;81(4):440–449.