Development of a collaborative drug therapy management protocol for extended-release intramuscular naltrexone

Abstract

The Center for Drug and Alcohol Programs (CDAP) at the Medical University of South Carolina (MUSC) focuses on research and clinical services for substance use disorders. CDAP is comprised of both inpatient and outpatient services. Outpatient services include an intensive program with daily group meetings and an individualized treatment program where patients are able to take part in one-on-one counseling. Approximately 1200 outpatients are seen in the CDAP clinics annually, 300 of which are in the intensive outpatient program. The patients seen in CDAP have a range of substance use disorders which include alcohol and opioid dependence, among others. Given the patient population, there is a significant demand for extended-release intramuscular naltrexone (ERIN), but the CDAP clinics are neither staffed nor structured for medication administration or storage. A previously established pharmacist-run clinic exists at MUSC for the purpose of administering long-acting injectable antipsychotics and monitoring the patients who receive them. An explanation of the financial impact of the antipsychotic injection clinic to our institution is described by Phan and Vandenberg. With the increasing patient and physician demand, a protocol was developed to allow pharmacists to administer ERIN in the pharmacist-run clinic.