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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. No disclosures

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XR-NTX Implementation in Los Angeles County

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  1. 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

  2. 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

  3. 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

  4. Background

  5. 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.

  6. Los Angeles County Vivitrol Pilot Project

  7. 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?

  8. 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

  9. 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)

  10. 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

  11. Results & Findings

  12. Participant Characteristics • *Lifetime report of mental illness differed between groups; p<.01

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

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

  15. 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)

  16. 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)

  17. 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)

  18. 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

  19. Any questions? Desiree A. Crevecoeur-MacPhail, Ph.D. desireec@ucla.edu 310-267-5207

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