Transcript What is XR-NTX (Vivitrol)? - Los Angeles County Evaluation System

XR-NTX Implementation in
Los Angeles County
Desirée A. Crèvecoeur-MacPhail, PhD
UCLA Integrated Substance Abuse Programs
11075 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
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 muopioid 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
Gender (Female)
Race/Ethnicity
White
African American
Latino
Other
Criminal Justice Involvement (yes)
Homeless status (yes)
Employment Activities (yes)
Program Type (Outpatient)
Mental Illness* (yes)
Vivitrol
Group
(% yes)
55.3%
Post-hoc
Group
(% yes)
56.8%
41.1%
13.2%
41.1%
4.7%
31.6%
40.5%
10%
35.3%
44.7%
43.7%
12.1%
40%
4.2%
33.2%
35.3%
14.2%
34.7%
32.1%
Statistic
X2 = 0.096
X2 = 0.323
X2 = .108
X2 = 1.118
X2 = 1.583
X2 = .012
X2 = 6.407
*Lifetime report of mental illness differed between groups; p<.01
Participant Characteristics
Vivitrol Group
Continuous
Variable
Mean (sd)
Post-hoc
Group
Mean (sd)
Test
Statistic
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
*Days spent on the wait list significantly differed between the groups p<.001.
Reduced Urge to Drink
Urge to Drink Scores Over First Month
20
17.2
15
10
9.6
7.1
5
6.2
0
Week 1
Week 2
Week 3
Week 4
Based on the Urge to Drink Scale, which is scored from 0 to 30.
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.
[email protected]
310-267-5207