VA Boston Healthcare System, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Am J Addict. 2018 Sep;27(6):524-530. doi: 10.1111/ajad.12786. Epub 2018 Aug 14.
Despite the promise of extended release naltrexone in the treatment of the opioid and alcohol use disorders, challenges with initiation and subsequent adherence have limited its potential. The purpose of this study is to identify the patient and treatment characteristics associated with adherence to extended release naltrexone.
Retrospective cohort study of 155 veterans who initiated the medication in FY 2014 and FY2015. Medical records were abstracted for patient and treatment data including preferred drug and utilization of substance use treatment in the year before and after medication initiation.
Sample characteristics include 94% male, 70% domiciled, 60% without current legal problems, 30% employed, and preferred drug being opioids for 55% and alcohol for 45%. The mean of five extended release naltrexone injections did not differ by preferred drug. Treatment variables associated with medication adherence included concurrent substance use residential, individual, group, and psychiatric therapies (all p < .05) with inpatient detoxification admissions halved afterward (p < .0001) .
Whereas most studies of extended release naltrexone have focused on patients with either alcohol or opioid use disorders for 6 months, this study allowed for a direct comparison of adherence in both groups over a year. The average treatment persistence in this veteran sample is greater than described in other public sector studies and may illustrate the importance of concurrent psychosocial therapies.
Results extend the findings of other studies and add to an emerging appreciation of the factors associated with treatment retention for extended release naltrexone. (Am J Addict 2018;27:524-530).
尽管纳曲酮长效制剂在治疗阿片类药物和酒精使用障碍方面具有广阔前景，但在起始和随后的坚持方面所面临的挑战限制了其应用潜力。本研究旨在确定与纳曲酮长效制剂坚持使用相关的患者和治疗特征。
对在 2014 财政年度和 2015 财政年度开始使用该药物的 155 名退伍军人进行回顾性队列研究。从病历中提取患者和治疗数据，包括开始用药前和用药后一年内的首选药物和物质使用治疗的使用情况。
样本特征包括 94%为男性、70%为定居者、60%没有当前法律问题、30%有工作，首选药物为 55%的阿片类药物和 45%的酒精。五次纳曲酮长效注射的平均值与首选药物无关。与药物坚持相关的治疗变量包括同时使用物质使用住院、个体、小组和精神治疗（均 P<.05），此后住院戒毒治疗减少了一半（P<.0001）。
虽然大多数关于纳曲酮长效制剂的研究都集中在患有酒精或阿片类药物使用障碍的患者，为期 6 个月，但本研究允许在一年的时间内直接比较两组患者的坚持情况。在退伍军人样本中，平均治疗持久性大于其他公共部门研究中描述的情况，这可能表明同时进行心理社会治疗的重要性。
结果扩展了其他研究的发现，并增加了对与纳曲酮长效制剂治疗保留相关因素的新认识。（Am J Addict 2018;27:524-530）。
