Initiating Long-acting Injectable Naltrexone: Procedure for a Second Attempt After a First Attempt Fails.

Shulman, Matisyahu; Hu, Mei Chen; Nunes, Edward V; Bisaga, Adam · J Addict Med

prospective_cohort · Level II

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Abstract

Many patients are unable to initiate long-acting injectable naltrexone (XR-NTX) on a first attempt, due to the prerequisite abstinence and withdrawal from opioids. Thirty patients who were unable to initiate XR-NTX were recruited to receive buprenorphine for 1 week, followed by a 3-week buprenorphine taper, and an ascending titration of oral naltrexone before XR-NTX injection. Eight (27%) initiated XR-NTX, 7 (23%) transitioned to buprenorphine maintenance treatment and 15 (50%) were lost to follow up. A second attempt at XR- NTX initiation using buprenorphine stabilization and cross taper may be a reasonable approach for some patients.

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