Presentation on theme: "XR-NTX Implementation in Los Angeles County Desirée A. Crèvecoeur-MacPhail, PhD UCLA Integrated Substance Abuse Programs 11075 Santa Monica Blvd., Suite."— Presentation transcript:
XR-NTX Implementation in Los Angeles County Desirée A. Crèvecoeur-MacPhail, PhD UCLA Integrated Substance Abuse Programs Santa Monica Blvd., Suite 200 Los Angeles, CA 90025
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 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)? 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.
Los Angeles County Vivitrol Pilot Project
Evaluation Questions 1.Willing to take multiple doses? 2.How did the Urge to Drink score change? 3.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 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 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 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
Results & Findings
Participant Characteristics Categorical Variable Vivitrol Group (% yes) Post-hoc Group (% yes)Statistic Gender (Female)55.3%56.8%X2 = Race/Ethnicity White African American Latino Other 41.1% 13.2% 41.1% 4.7% 43.7% 12.1% 40% 4.2% X2 = Criminal Justice Involvement (yes)31.6%33.2%X2 =.108 Homeless status (yes)40.5%35.3%X2 = Employment Activities (yes)10%14.2%X2 = Program Type (Outpatient)35.3%34.7%X2 =.012 Mental Illness* (yes)44.7%32.1%X2 = *Lifetime report of mental illness differed between groups; p<.01
Participant Characteristics *Days spent on the wait list significantly differed between the groups p<.001. Continuous Variable Vivitrol Group Mean (sd) Post-hoc Group Mean (sd) Test Statistic Age at Admission37.2 (9.5)36.8 (10.7)t(374) = Age at First Use17.1 (6.3)17 (6.1)t(378) = Days of Primary Drug in the Last (9.5)10.2 (11.3)t(378) = # of Prior Treatment Episodes2.2 (3.7)2 (6)t(378) = Days on Wait List*7.2 (13.6)3.7 (10.5)t(378) = Age at Admission37.2 (9.5)36.8 (10.7)t(374) = Age at First Use17.1 (6.3)17 (6.1)t(378) = -.173
Reduced Urge to Drink Based on the Urge to Drink Scale, which is scored from 0 to 30.
Limited Side Effects Proportion Reporting Side Effect for Weeks 1 – 4 After First Dose
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) = ( ) –Age at first use (p <.05) OR (95% CI) = ( )
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) = (2.352 – 6.361) –Race (African American vs. White) (p <.05) OR (95% CI) =.380 ( ) –Mental illness diagnosis (p <.01) OR (95% CI) = (1.370 – 4.258)
XR-NTX & Pos Compliance Positive Compliance = Discharge status –Vivitrol group (78.4%) –Comparison group (60%) Predictors included –XR-NTX (p <.001) OR (95% CI) = (1.665 – 4.595) –Age at first use (p <.01) OR (95% CI) = ( ) –Employment activities (p <.01) OR (95% CI) =.318 ( )
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? Desiree A. Crevecoeur-MacPhail, Ph.D