XR-NTX Implementation in Los Angeles County

Desirée A. Crèvecoeur-MacPhail, PhDUCLA Integrated Substance Abuse Programs

11075 Santa Monica Blvd., Suite 200Los 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

Background

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-hocGroup(% yes) Statistic

Gender (Female) 55.3% 56.8% X2 = 0.096Race/Ethnicity White African American Latino Other

41.1%13.2%41.1%4.7%

43.7%12.1%40%4.2%

X2 = 0.323

Criminal Justice Involvement (yes) 31.6% 33.2% X2 = .108Homeless status (yes) 40.5% 35.3% X2 = 1.118Employment Activities (yes) 10% 14.2% X2 = 1.583Program Type (Outpatient) 35.3% 34.7% X2 = .012Mental Illness* (yes) 44.7% 32.1% X2 = 6.407

*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.

ContinuousVariable

Vivitrol Group

Mean (sd)

Post-hocGroup

Mean (sd)

TestStatistic

Age at Admission 37.2 (9.5) 36.8 (10.7) t(374) = -.469

Age at First Use 17.1 (6.3) 17 (6.1) t(378) = -.173

Days of Primary Drug in the Last 30

8.2 (9.5) 10.2 (11.3) t(378) = 1.877

# of Prior Treatment Episodes 2.2 (3.7) 2 (6) t(378) = -.463

Days on Wait List* 7.2 (13.6) 3.7 (10.5) t(378) = -2.826

Age at Admission 37.2 (9.5) 36.8 (10.7) t(374) = -.469

Age at First Use 17.1 (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.

Week 1 Week 2 Week 3 Week 4 02468

101214161820

17.2

9.67.1

6.2

Urge to Drink Scores Over First Month

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)

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)

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)

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.

desireec@ucla.edu

310-267-5207