Extended-release Injectable Naltrexone: A Significant Opportunity for Treating Opioid Use Disorder
SAMHSA Blog; Melinda Campopiano, M.D., Brandon T. Johnson, M.B.A.; 1/8/2015
In the United States, the profile of opioid misuse and opioid use disorder is changing. Nonmedical use of prescription opioids has become as significant a problem as heroin use. In 2013, approximately 4.5 million people reported nonmedical use of prescription pain relievers in the past month and 289,000 reported use of heroin in the past month. Despite the enormity of the problem, the vast majority of people with an opioid use disorder do not receive medication-assisted treatment (MAT) because of limited treatment capacity, financial obstacles, social bias, and other barriers to care.
SAMHSA sees the use of extended-release injectable naltrexone as a breakthrough for treating opioid use disorder and has recently issued new guidance on the clinical use of this form of naltrexone. Researchers, federal agencies, and pharmaceutical manufacturers have focused on developing medications such as extended-release injectable naltrexone that can be used to expand access to treatment of an opioid use disorder in medical office settings, rather than limiting use to specialized opioid treatment programs.
SAMHSA, along with the National Institute on Drug Abuse (NIDA), jointly convened the Consensus Panel on New Pharmacotherapies for Opioid Use Disorders and Related Comorbidities. This new guidance, titled Clinical Use of Extended-Release Injectable Naltrexone in the Treatment of Opioid Use Disorder: A Brief Guide, presents the panel’s guidance based on a review of the current evidence on the effectiveness of available medications for the treatment of opioid use disorders by experts in research, clinical care, medical education, and public policy.
This document covers key information on assessing the patient’s need for treatment, initiating MAT, monitoring patient progress and adjusting the treatment plan, and deciding whether and when to end MAT. It also includes a summary of the key differences between methadone, buprenorphine, and extended-release injectable naltrexone.
Having reviewed numerous studies, many addiction specialists have concluded that patients who have an opioid use disorder should be offered MAT on a routine basis. However, considerable resistance to the use of such treatments persists. A diagnosis of opioid use disorder continues to carry significant social bias, which affects both the individuals who receive the diagnosis and the healthcare professionals to whom such individuals may turn for care.
There is a significant opportunity to address the unmet need for treating opioid use disorder by integrating MAT with extended-release injectable naltrexone into existing substance use treatment programs as well as primary care and community mental health care settings. Many studies show that treatment of an opioid use disorder can be successfully integrated into general office practice by physicians and healthcare providers who are not addiction specialists.