Perspectives on extended-release naltrexone induction among patients living with HIV and opioid use disorder: a qualitative analysis

Kim A Hoffman, Robin Baker, Laura C Fanucchi, Paula J Lum, Lynn E Kunkel, Javier Ponce Terashima, Dennis McCarty, Petra Jacobs, P Todd Korthuis, Kim A Hoffman, Robin Baker, Laura C Fanucchi, Paula J Lum, Lynn E Kunkel, Javier Ponce Terashima, Dennis McCarty, Petra Jacobs, P Todd Korthuis

Abstract

Background: The CHOICES study randomized participants with HIV and opioid use disorder (OUD) to HIV clinic-based extended-release naltrexone (XR-NTX), which requires complete cessation of opioid use, versus treatment-as-usual (i.e., buprenorphine, methadone). Study participants randomized to XR-NTX were interviewed to assess their experiences with successful and unsuccessful XR-NTX induction.

Methods: Semi-structured qualitative interviews were completed with a convenience sample of study participants with HIV and OUD (n = 37) randomized to XR-NTX in five HIV clinics between 2018 and 2019. All participants approached agreed to be interviewed. Interviews were digitally recorded, professionally transcribed, and analyzed using thematic analysis.

Results: Participants included women (43%), African Americans (62%) and Hispanics (16%), between 27 to 69 years of age. Individuals who completed XR-NTX induction (n = 20) reported experiencing (1) readiness for change, (2) a supportive environment during withdrawal including comfort medications, and (3) caring interactions with staff. Four contrasting themes emerged among participants (n = 17) who did not complete induction: (1) concern and anxiety about withdrawal including past negative experiences, (2) ambivalence about or reluctance to stop opioids, (3) concerns about XR-NTX effects, and (4) preferences for other medications.

Conclusions: The results highlight opportunities to improve initiation of XR-NTX in high-need groups. Addressing expectations regarding induction may enhance XR-NTX initiation rates. Trial Registration ClinicalTrials.gov: NCT03275350. Registered September 7, 2017. https://ichgcp.net/clinical-trials-registry/NCT03275350?term=extended+release+naltrexone&cond=Opioid+Use .

Keywords: Extended-release naltrexone; HIV; Induction; Opioid use disorder; Opioid withdrawal.

Conflict of interest statement

Alkermes (a global biopharmaceutical company) donated the extended-release naltrexone used in the study protocol. The authors report no additional competing interests.

© 2021. The Author(s).

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