Residential initiation of extended-release naltrexone and follow-up in opioid-dependent patients vs. case-matched controls

Abstract

s / Drug and Alcohol Dependence 140 (2014) e86–e168 e149 Residential initiation of extended-release naltrexone and follow-up in opioid-dependent patients vs. case-matched controls Roger E. Meyer1, W. Milchak1, D. Leslie2, E.O. Bixler1, Kathleen T. Brady3, P. Herschman4, G.D. Shulman5, D.R. Gastfriend6 1 Psychiatry, Penn State Hershey Medical Center, Hershey, PA, United States 2 Public Health Sciences, Penn State Hershey Medical Center, Hershey, PA, United States 3 Psychiatry, MUSC, Charleston, SC, United States 4 CRC Health Group, Carlsbad, CA, United States 5 Shulman & Associates, Jacksonville, FL, United States 6 Alkermes, Inc., Waltham, MA, United States Aims: A naturalistic study of the effectiveness and costs of XR-NTX for opioid dependence initiated during residential rehabilitation. Methods: Retrospective examination of electronic records at 3 PA-based detox/rehab sites owned by CRC Health Group. We compared 2 groups that were Medicaid supported and referred for intensive outpatient treatment at a Pennsylvania CRC site: XR-NTX vs. non XR-NTX (n=75 each): case-mix adjusted, using demographic, clinical and service parameters. We reviewed discharge summaries and OPD records for adherence to injections and outpatient care, drug use and estimated healthcare costs. Results: 7687 opioid dependent patients admitted in 2011; 430, XR-NTX recommended but not received; another 168 patients did receive XR-NTX. Medicaid covered 84.5% (n=142) of XR-NTX patients, who were more likely to complete inpatient (93.5% vs. 63.0%; p< .001). Only 4.8% of the XR-NTX treated group were discharged against medical advice vs. 30.2% (p< .001). Data were further analyzedonOPDoutcomesof randomly selected75XR-NTX pts and case-mix adjusted controls. Conclusions: This is the first effectiveness and cost analysis study of XR-NTX for opioid dependence in a Medicaid cohort. Data indicate improved Pt completion of inpatient care with XR-NTX. Furtherdata analysis usinga case-matchedcontrol groupexamined treatment adherence in OPD, drug use and psychosocial functioning, and the estimated relative costs of the specific treatments received by each cohort. The findings have potential policy ramifications. Financial support: Supported by a research services agreement from Alkermes Inc., to Penn State University. Dr. Herschman is an employee of CRC Health Group, Inc. Dr. Gastfriend is a full-time employee of Alkermes. XR-NTX (VIV-ITROL®) was developed with grants from NIDA (R43DA013531) and NIAAA (N43AA001002). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.421 Examining polygenic risk of cigarette use in the Detroit Neighborhood Health Study Jacquelyn L. Meyers1, S. Galea1, A. Aiello2, M. Uddin2, D. Wildman3, K. Koenen1 1 Epidemiology, Columbia University Medical Center, New York, NY, United States 2 Epidemiology, University of Michigan, Ann Arbor, MI, United States 3 Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, United States Aims: Cigarette smoking is influenced both by genetic and environmental factors (Bromset al., 2006). Until this year, all large-scale gene identification studies on smoking were conducted in populations of European descent. Recently, a metaanalysis of smoking in 32,389 African-Americans was conducted (David et al., 2012). This study produced one genetic variant of genome wide significance and eight additional variants that were approaching significance. The stringent significance threshold, put in place to protect against high rates of false positives, demands that in order to detect a statistically significant signal, large, ethnically homogeneous samples are required. This motivates the further investigation of the top variants reported in this meta-analysis in the Detroit Neighborhood Health Study (DNHS), 1306 randomly selected majority African American residents of Detroit, with DNA collected on 778 individuals. Methods: In the DNHS,we have constructed a genetic risk score (GRS) in which we have combined these top genetic variants, in an effort to more accurately model the genetic architecture of smoking behaviors and potentially account for a greater portion of the variance in these traits. Results: Among individuals who had been exposed to nicotine, had data available on cigarette use and DNA collected, the GRS significantly (beta = .14, p-value = .04) predicted cigarettes per day and accounted for ∼3% of the overall variance in the trait. In addition, significant interactions were observed between this GRS and several aspects of the individual’s social context, including social cohesion and experiencing traumatic events. Conclusions: Because of the sample size, this study is limited in the potential strength of the association signal, however this study provides support for the utility of the GRS as an alternative approach to replication of common polygenic variation, and gene–environment interactions, in smoking behaviors. Financial support: NIH Grants: DA022720, R01AG012975. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.422 Modeling inter-relationships among longitudinal non-normal outcomes: Trajectories of daily use of different drugs during treatment Susan K. Mikulich-Gilbertson, G.O. Zerbe, P.D. Riggs Psychiatry, University of Colorado, Aurora, CO,