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XR-NTX Implementation in Los Angeles County. Desirée A. Crèvecoeur-MacPhail, PhD UCLA Integrated Substance Abuse Programs 11075 Santa Monica Blvd., Suite 200 Los Angeles, CA 90025. D isclosures. No disclosures

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xr ntx implementation in los angeles county

XR-NTX Implementation in Los Angeles County

Desirée A. Crèvecoeur-MacPhail, PhD

UCLA Integrated Substance Abuse Programs

11075 Santa Monica Blvd., Suite 200

Los Angeles, CA 90025

d isclosures
Disclosures
  • No disclosures
  • Evaluation and medication paid for by the County of Los Angeles Department of Public Health, Substance Abuse Prevention and Control
  • I have no conflicts of interest – not affiliated with Alkermes
acknowledgements
Acknowledgements
  • Could not have done this study without:
    • Sarah J. Cousins, MPH
    • Loretta L. Denering, MS
    • Stefanie Weimann, MA
    • Eva Vasquez
    • Richard A. Rawson, PhD
    • Dave Bennett, BA
    • Mary-Lynn Brecht, PhD
what is xr ntx vivitrol
What is XR-NTX (Vivitrol)?
  • Injectable extended release naltrexone (XR-NTX) was FDA approved in 2006, for the treatment of alcoholism
    • In 2011, the FDA approved “Vivitrol” for the treatment of opiate addiction.
  • An opioid receptor antagonist, that blocks the mu-opioid receptors in the brain
    • Mu-opioid receptors are responsible for the “high” or “buzz” individuals feel when alcohol is consumed.
evaluation questions
Evaluation Questions
  • Willing to take multiple doses?
  • How did the Urge to Drink score change?
  • And when compared to the Post-hoc group, what proportion of the Vivitrol group:
  • Engaged in treatment (LOS 30 days or more)?
  • Retained in treatment (LOS 90 days or more)?
  • Was compliant in treatment?
evaluation design
Evaluation Design
  • No Random Assignment
  • Alcohol only
  • The three medication hubs
    • Clients went to hubs for medication and returned for psychosocial treatment
  • Hub selection criteria:
    • Infrastructure to administer medications
    • Long-standing histories of providing quality substance abuse treatment
data collection
Data Collection
  • Treatment Outcome Data
    • Los Angeles County Participant Reporting System (LACPRS)
      • Outcomes, length of stay
  • Patient Response to Vivitrol
    • Medically Assisted Treatment Survey (MATS)
    • Urge to Drink Scale (UDS)
two groups
Two Groups
  • Vivitrol Group (n = 190)
    • Received at least one dose of medication
    • No random assignment – wanted medication, got medication
  • Post-hoc Comparison Group (n = 190)
    • Did not receive medication
    • Demographics matched to Vivitrol group
    • Calculated propensity scores
participant characteristics
Participant Characteristics
  • *Lifetime report of mental illness differed between groups; p<.01
participant characteristics1
Participant Characteristics

*Days spent on the wait list significantly differed between the groups p<.001.

reduced urge to drink
Reduced Urge to Drink

Based on the Urge to Drink Scale, which is scored from 0 to 30.

xr ntx engagement
XR-NTX & Engagement
  • Engagement = In treatment for 30+ days
    • Vivitrol group (96.3%)
    • Comparison group (72.1%)
  • Predictors included
    • XR-NTX (p < .001)
      • OR (95% CI) = 12.609 (5.178-30.706)
    • Age at first use (p < .05)
      • OR (95% CI) = 1.066 (1.009-1.126)
xr ntx retention
XR-NTX & Retention
  • Retention = In treatment for 90+ days
    • Vivitrol group (72.1%)
    • Comparison group (43.7%)
  • Predictors included
    • XR-NTX (p < .001)
      • OR (95% CI) = 3.868 (2.352 – 6.361)
    • Race (African American vs. White) (p < .05)
      • OR (95% CI) = .380 (.175 - .826)
    • Mental illness diagnosis (p <.01)
      • OR (95% CI) = 2.415 (1.370 – 4.258)
xr ntx pos compliance
XR-NTX & Pos Compliance
  • Positive Compliance = Discharge status
    • Vivitrol group (78.4%)
    • Comparison group (60%)
  • Predictors included
    • XR-NTX (p < .001)
      • OR (95% CI) = 2.766 (1.665 – 4.595)
    • Age at first use (p < .01)
      • OR (95% CI) = 1.062 (1.018 - 1.109)
    • Employment activities (p < .01)
      • OR (95% CI) = .318 (.134 - .755)
conclusions
Conclusions
  • No causal conclusions (no random assignment)
  • Increased the number of patients who were engaged and retained in treatment and who left treatment with positive compliance
  • Limited side effects reported by approx a quarter of patients
any questions

Any questions?

Desiree A. Crevecoeur-MacPhail, Ph.D.

desireec@ucla.edu

310-267-5207