Successful Clinical Trial For Opiate Treatment Among Prison Inmates Led By Baystate Researcher

A new study appearing in the New England Journal of Medicine shows potentially life-saving results when it comes to preventing opiate relapses and overdoses among prison inmates with known addictions.

The study, titled “Extended-Release Naltrexone to Prevent Opioid Relapse In Criminal Justice Offenders,” was completed by over a dozen experts in addiction medicine and treatment across the region. Dr. Peter Friedmann, M.D., M.P.H., chief research officer at Baystate Health and a nationally recognized expert in addiction medicine, is a lead researcher in the study. With an ongoing opiate epidemic plaguing the northeast, experts say it is critical to find new and innovative ways to treat the substance abuse addictions of those who are incarcerated, so that they have the best possible chance of reintegrating into the community when released from prison.

The typical treatment for opioid addicted inmates consists of brief counseling and referrals for community substance abuse treatment programs, all in an effort of preventing opioid relapses when they are released. This randomized trial took place in five northeast locations over a 24-week period. A total of 155 participants were assigned to the typical community based treatment program that inmates routinely take part in. At the same time, 153 trial participants were assigned to receive extended-release Vivitrol, a prescription injectable medicine used to treat substance abuse dependence. The study focused on inmates who have a desire to be completely opioid-free, rather than ones who would prefer opioid maintenance programs, such as a Methadone program. To be part of the trial, individuals had to be involved with the U.S. criminal justice system and be abstinent from opioids at the time of randomization.

During the 24-week treatment phase, participants assigned to the extended release Vivitrol had a longer median time to relapse than did those assigned to usual treatment, a lower rate of relapse (43{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} vs. 64{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of participants), and a higher rate of opioid-negative urine samples. While rates of opioid-free urine samples were equal in both groups after 78 weeks of observance, the study appeared effective in saving lives. There were ZERO overdose events in the extended-release Vivitrol group and seven in the usual-treatment group.

Overall, extended-release Vivitrol was associated with a rate of opioid relapse that was lower than that with usual treatment.

“Given the twin epidemics of opiate addiction and incarceration in our communities, it is essential to deliver effective medical treatment to opioid users who are involved with the criminal justice system” said Friedmann. “These individuals are at high risk of overdose and death, and effective medications have been proven to save lives.  We also want to give these individuals an opportunity to start anew and rebuild their lives. This study demonstrates that injectable, long-acting naltrexone provides another effective tool for physicians, advanced practitioners and the criminal justice system to address the opioid crisis one patient at a time.”