Extended-Release Naltrexone vs. Buprenorphine-Naloxone: A Comparative Effectiveness Trial
Date & Time
Wednesday, April 4, 2018, 3:45 PM - 5:00 PM
Joshua Lee, MD, MSc, Professor, Department of Population Health, New York University School of Medicine
Edward Nunes, MD, Professor of Psychiatry, Columbia University Medical Center / New York State Psychiatric Institute
Moderator: David Tapp, JD, MS, Judge, 28th Judicial Circuit of Kentucky, and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
CE Certified By: AMA,AAFP,ACPE,ANCC
Extended-release naltrexone (XR-NTX), an opioid antagonist, and buprenorphine-naloxone (BUP-NX), a partial opioid agonist, are medications available for office-based treatment that represent divergent approaches to opioid relapse prevention, i.e. opioid-free versus opioid-maintenance therapies. With respect to the choice between these widely used treatment options, important comparative effectiveness issues — e.g., questions regarding the relative feasibility of initiating treatment, rates of relapse to illicit opioid use, retention in treatment, and overdose and other safety concerns — have not been rigorously addressed. To fill this critical knowledge gap, the National Institute on Drug Abuse National Drug Abuse Treatment Clinical Trials Network conducted a multi-site comparative effectiveness trial with 570 adults admitted to inpatient opioid detoxification centers were randomly assigned to receive monthly XR-NTX or daily BUP-NX for 24 weeks of outpatient treatment.
In this session, the presenters will provide an overview of the trial's design and its main treatment effectiveness and safety outcomes. They will describe key secondary findings, including the results of analyses of predictors of treatment success and their implications for patient-treatment matching. Discussion will place the trial's findings in the context of the broader scientific evidence base that supports the use of XR-NTX and BUP-NX and describe how the cumulative evidence might inform the decisions of patients, clinical providers, and healthcare policymakers weighing a choice between these treatment approaches.
UPON COMPLETION OF THIS COURSE, PARTICIPANTS WILL BE ABLE TO:
- Describe how extended-release naltrexone and buprenorphine differ as opioid use disorder treatments.
- Explain the primary and key secondary findings of the National Institute on Drug Abuse National Drug Abuse Treatment Clinical Trials Network comparative effectiveness trial.
- Apply lessons learned from the National Institute on Drug Abuse National Drug Abuse Treatment Clinical Trials Network trial and related studies to clinical decision-making.