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J Subst Abuse Treat. 2018 Feb;85:66-69. doi: 10.1016/j.jsat.2017.05.009. Epub 2017 May 12.

Healthcare utilization in adults with opioid dependence receiving extended release naltrexone compared to treatment as usual.

Author information

1
Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut St. Springfield, MA 01199, United States. Electronic address: William.soaresMD@baystatehealth.org.
2
Baystate Medical Center, 759 Chestnut St. Springfield, MA 01199, United States. Electronic address: donna.wilson@baystatehealth.org.
3
Baystate Medical Center, 759 Chestnut St. Springfield, MA 01199, United States. Electronic address: Niels.rathlev@baystatehealth.org.
4
Department of Population Health, New York University, 227 E. 30th St., New York, NY 10016, United States. Electronic address: joshua.lee@nyumc.org.
5
Friends Research Institute, 1040 Park Avenue, Baltimore, MD 21201, United States. Electronic address: mgordon@friendsresearch.org.
6
Columbia University Medical Center, 617 West End Avenue, New York, NY 10024, United States. Electronic address: Nunesed@nyspi.columbia.edu.
7
Department of Psychiatry, University of Pennsylvania, Department of Behavior Health, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States. Electronic address: obrien@mail.med.upenn.edu.
8
Baystate Medical Center, 759 Chestnut St. Springfield, MA 01199, United States. Electronic address: Peter.friedmannmd@baystatehealth.org.

Abstract

BACKGROUND:

Opioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12months post-treatment follow up.

METHODS:

This retrospective exploratory analysis uses data collected in a published randomized trial. Comparisons of the number of emergency department visits and hospital admissions (for drug detox, psychiatric care and other medical reasons) were performed using chi square tests for any admission and negative binomial models for number of admissions.

RESULTS:

Of the 308 participants randomized, 96% had utilization data (76% complete 6months, 67% complete follow up). No significant differences were seen in overall healthcare utilization (IRR=0.88, 95%CI 0.63-1.23, p=0.45), or substance use-related drug detox hospitalizations (IRR=0.83, 95%CI 0.32-2.16, p=0.71). Despite having more participants report chronic medical problems at baseline (43% vs. 32%, p=0.05), those receiving XR-NTX generally experienced equivalent or lower rates of healthcare utilization compared to TAU. The XR-NTX group had significantly lower medical/surgical related hospital admissions (IRR=0.55, 95%CI 0.30-1.00, p=0.05) during the course of the entire study.

CONCLUSIONS:

XR-NTX did not significantly increase rates of healthcare utilization compared to TAU. Provider concerns regarding healthcare utilization should not preclude the consideration of XR-NTX as therapy for opioid use disorders.

KEYWORDS:

Criminal justice population; Healthcare utilization; Long acting naltrexone; Opioid use disorders

PMID:
28576389
DOI:
10.1016/j.jsat.2017.05.009

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