A clinical trial supported by the National Institutes of Health’s National Institute on Drug Abuse (NIDA) has found that starting people with opioid use disorder on extended-release, injectable naltrexone (XR-naltrexone) within five to seven days of seeking treatment is more effective than the standard treatment method of starting within 10-15 days. This rapid treatment protocol could make XR-naltrexone a more viable treatment option for opioid use disorder, which continues to take lives at an alarming rate. XR-naltrexone works by binding to and blocking opioid receptors in the brain, reducing cravings and preventing the effects of opioids. Traditionally, starting treatment with XR-naltrexone required patients to go through a seven to 10-day opioid-free period, which posed a significant barrier to implementation of this medication.
To address this challenge, researchers tested the effectiveness of a more rapid procedure to start people with opioid use disorder on XR-naltrexone. The study enrolled and followed 415 patients with opioid use disorder who were admitted at six community-based inpatient addiction facilities across the U.S. and who chose treatment with XR-naltrexone. The study found that patients on the rapid five to seven-day treatment procedure were significantly more likely to receive a first injection of XR-naltrexone compared to those on the standard seven to 15-day treatment procedure. Withdrawal severity was generally low and comparable across the two groups, but safety events and serious adverse events occurred more frequently in the rapid procedure group, indicating closer monitoring may be needed.
Challenges remain in starting patients on XR-naltrexone and keeping them in treatment long term, despite the shorter wait-time improving the proportion of people who began treatment with XR-naltrexone overall. The most common reason for participants not receiving a first dose of XR-naltrexone was that they chose to leave the treatment unit early. Only about 10% of all patients entering treatment chose XR-naltrexone, highlighting the importance of supporting research into making this treatment option more viable for those who choose it. Future studies should explore the sustainability, feasibility, and health economic aspects of the more rapid treatment protocol for XR-naltrexone.
In 2022, over 107,000 people died of a drug overdose, with 75% of those deaths involving an opioid, largely due to the proliferation of illicit fentanyl. Decades of research have shown the benefit of existing medications for opioid use disorder, including methadone, buprenorphine, and XR-naltrexone. The SWIFT study, conducted at six sites within the NIDA Clinical Trials Network and funded through NIH’s Helping to End Addiction Long-Term Initiative, aimed to address barriers to using XR-naltrexone for opioid use disorder. The study was led by researchers at New York State Psychiatric Institute and Columbia University Irving Medical Center.
The authors of the study hope that these findings will encourage more treatment settings to offer XR-naltrexone as a safe and effective option for patients seeking treatment for opioid use disorder. Despite the cost savings from fewer days on the rapid procedure, the resources needed for intensive monitoring should also be considered. As opioid overdoses continue to rise, it is essential to explore new treatment options and protocols to improve outcomes for individuals struggling with opioid addiction. Further research is needed to continue refining and optimizing treatment options for opioid use disorder to support recovery and prevent overdose deaths.
