Prescribing Patterns of XR-Naltrexone for Treating OUD by Nevada Addiction Specialists

Abstract

Prescribing Patterns of XR-Naltrexone for Treating OUD by Nevada Addiction Specialists Samia Mouaki-Benani, OMS-II; smouaki@student.touro.edu Ansab Sheikh, OMS-II; asheikh5@student.touro.edu Joseph P. Hardy, MD, Associate Dean for Clinical Education Weldon Havins, MD, JD, LLM, FCLM Touro University Nevada College of Osteopathic Medicine Background: The Opioid crisis is a nationwide epidemic with devastating consequences to American communities and public health. In 2018, 46,802 (70%) of all overdose deaths in the United States, and 372 drug overdose deaths in Nevada, were opioid-related. Medication-assisted treatment (MAT) is an effective “whole-patient” approach to the treatment of opioid use disorder (OUD), combining medications with behavioral therapy and counseling. There are three FDAapproved medications indicated for opioid dependency: naltrexone, methadone, and buprenorphine. Treatment centers rarely offer naltrexone (XR-NTX, or Vivitrol available in injectable extended release form) compared with opioid agonist treatments. The goal of this study is to quantify prescribing patterns of MAT to treat OUD in Nevada and to understand the reasons addiction specialists do or do not prescribe it. Methods: A survey was created with questions designed and sent to practicing Nevada addiction specialists, including physicians (MD and DO), physician assistants, and nurse practitioners in the state of Nevada (Nevada Addiction Specialists hereafter), by mail. Results: Of 309 Nevada Addiction Specialists surveyed, 34 (11%) responded. Almost half (47%) of responding addiction specialists in Nevada prescribed XR-NTX, yet only 9% of OUD patients were treated with XR-NTX. The leading reasons addiction specialists prescribed XRNTX were the frequency of injections and the non-addictive nature of the drug. The leading reasons for not prescribing XR-NTX were its detoxification requirement (35% of respondents), accessibility (29%), and price (24%). Of the Nevada addiction specialists who did not prescribe XR-NTX, 28% were unfamiliar with the drug. Conclusion: The survey results suggest that XR-NTX is appropriate for only a small subset of patients with OUD, as indicated by the CDC and other studies. XR-NTX has potential in highly motivated patients that are 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 27–28 https://doi.org/10.1080/01947648.2021.1914481 willing to abstain from opioid use during the detox period, those willing to pay the higher cost, and patients in the criminal justice system. There may be a need for increasing awareness and education of MAT options earlier in medical training to bridge the gap in knowledge related to the treatments available for patients with OUD. The generalizability of this study is limited by the small number of respondents. References available upon request 28 ABSTRACT