Characteristics and treatment preferences of individuals with opioid use disorder seeking to transition from buprenorphine to extended-release naltrexone in a residential setting

Abstract

Background and objectives: Treatment for individuals receiving medication for opioid use disorder (MOUD) should follow an informed patient-centered approach. To better support patient autonomy in the decision-making process, clinicians should be aware of patient preferences and be prepared to educate and assist patients in transitioning from one MOUD to another, when clinically indicated. This posthoc analysis describes the characteristics of clinical trial participants (NCT02696434) with a history of opioid use disorder (OUD) seeking to transition from buprenorphine (BUP) to extended-release naltrexone (XR-NTX).

Methods: The posthoc analysis included adults with OUD currently receiving BUP (≤8 mg/day) and seeking transition to XR-NTX (N = 101) in a residential setting. Baseline participant characteristics and OUD treatment history were reviewed. All patients completed a screening questionnaire that asked about their reasons for seeking transition to XR-NTX and for choosing BUP.

Results: The most common reasons for initiating a transition to XR-NTX were "Seeking to be opioid-free" (63.4%) and "Tired of daily pill taking" (25.7%). Positive predictors of transition included a more extensive BUP treatment history and a history of prescription opioid abuse. Most participants stated they were not aware of XR-NTX as a treatment option when initiating BUP (78.2%).

Discussions and conclusions: Patients' reasons for seeking XR-NTX transition, more extensive BUP treatment history, and a history of prescription opioid abuse, may positively predict outcomes.

Scientific significance: These findings may assist clinicians in optimizing outcomes of the BUP to XR-NTX transition and supporting patients to make better informed MOUD decisions.

Conflict of interest statement

Paolo Mannelli, MD, has received consultation fees andgrants from Alkermes and other pharmaceutical companies. Antoine B Douaihy, MD,has participated in advisory boards and received grants from Alkermes. Sarah C.Akerman, MD is an employee and may be a shareholder of Alkermes, Inc. AbigailZavod, MD, MPH; Anna Legedza, ScD; James Fratantonio, PharmD; and Maria A.Sullivan, MD, PhD, are former employees of Alkermes, Inc.

© 2022 Alkermes, Inc. The American Journal on Addictions published by Wiley Periodicals LLC on behalf of The American Academy of Addiction Psychiatry (AAAP).

Figures

FIGURE 1

Opioid use of participants seeking to transition from buprenorphine (BUP) to extended‐release naltrexone. (a) Duration of opioid use disorder (OUD) before current BUP course of treatment (at baseline). (b) History of opioid use during active OUD (before study entry). IN, intranasal; IV, intravenous; Rx, prescription

FIGURE 2

Buprenorphine (BUP) treatment of participants seeking to transition from BUP to extended‐release naltrexone. (a) Number of previous BUP treatment courses (at baseline). (b) Length of current BUP treatment course (at baseline)

FIGURE 3

Questionnaire results of participants seeking to transition from buprenorphine (BUP) to extended‐release naltrexone (XR‐NTX) (as per a questionnaire with pre‐populated answer choices). (a) Primary reason for the transition from BUP to XR‐NTX (at screening). Participants were asked, “What is your main reason for wanting to transition from BUP to VIVITROL?” Answer choices consisted of the following: “Seeking to be opioid‐free,” “Tired of daily pill taking,” “Side effects from BUP,” “Still experiencing cravings for opioids,” “Using opioids/lapses while on BUP,” “Work‐related concerns,” “Childcare‐related concerns,” “Transportation is inconvenient,” “Hassle of filling prescriptions,” “Concerns about BUP being lost/stolen,” “BUP requires too many appointments,” “Cost considerations,” or “Other.” The reported “Side effects from BUP” were sweats/chills (n = 2), dizziness/lightheadedness (n = 1), drowsiness/sleepiness (n = 1), other (n = 1), and mental slowing (n = 1). (b) Awareness of XR‐NTX as a treatment option when BUP was initiated (at screening). Participants were asked “Why did you choose BUP?” Answer choices consisted of the following: “Not aware of VIVITROL at the time,” “Seeking outpatient detox/transition to medication‐assisted treatment,” “Cost considerations,” “Provider encourages BUP over other treatments,” “Positive experience with non‐prescription ‘street’ BUP,” “BUP was available by prescription from doctor's office,” “Concerns about withdrawal symptoms on VIVITROL,” or “Other.” For (a) and (b), only one answer could be selected, and “None of the above” was not included as an option