Review of: Fishman M et al, Addiction 2020 Jul 4. https://doi.org/10.1111/add.15181

We often use injectable extended-release naltrexone (XR-NTX, or Vivitrol) for management of opioid use disorder (OUD). However, XR-NTX has not been widely used in young adults with OUD, possibly due to low patient engagement and treatment adherence. This study evaluated the effectiveness of a youth opioid recovery support (YORS) model to promote XR-NTX adherence. YORS is a comprehensive treatment program that includes family support and other elements.

The 24-week study included 41 participants aged 18–26 years who were enrolled in a substance use disorder treatment program in Baltimore, MD, and were seeking treatment with XR-NTX. 21 patients were randomly assigned to the YORS treatment and 20 were assigned to treatment as usual (TAU). The YORS intervention included home delivery of XR-NTX, outreach to patients and families about treatment adherence, and monetary rewards for adherence to XR-NTX doses. TAU participants received standard referrals to continuing OUD care, including arrangements for ongoing treatment with XR-NTX. The mean age of all participants was 23.4 years. 65.8% of subjects were male, and 94.7% were Caucasian. Funding for the study was provided by the Laura and John Arnold Foundation.

The YORS participants obtained more XR-NTX doses (mean = 4.28; standard deviation [SD] = 2.3) compared to the TAU group (mean = 0.70; SD = 1.2) with p < 0.01. They also exhibited lower rates of relapse (61% vs 95%; p < 0.01). Group differences in time to opioid relapse were seen with TAU participants being at higher risk for earlier relapse (hazard ratio 2.72). No group differences were observed in the rates of continuous opioid abstinence over time, and only 1 subject maintained total opioid abstinence by 24 weeks.

CATR’s Take
This small study suggests the YORS intervention shows promise in improving treatment adherence with XR-NTX and relapse outcomes in young adults with OUD. More data are needed to shed additional light on the logistical and financial feasibility of this model in real-world clinical settings.