1. XR-NTX Implementation in Los Angeles County Desirée A. Crèvecoeur-MacPhail, PhD UCLA Integrated Substance Abuse Programs 11075 Santa Monica Blvd., Suite 200 Los Angeles, CA 90025

2. Disclosures No disclosures Evaluation and medication paid for by the County of Los Angeles Department of Public Health, Substance Abuse Prevention and Control I have no conflicts of interest – not affiliated with Alkermes

3. Acknowledgements Could not have done this study without: –Sarah J. Cousins, MPH –Loretta L. Denering, MS –Stefanie Weimann, MA – Eva Vasquez –Richard A. Rawson, PhD –Dave Bennett, BA –Mary-Lynn Brecht, PhD

4. Background

5. What is XR-NTX (Vivitrol)? Injectable extended release naltrexone (XR-NTX) was FDA approved in 2006, for the treatment of alcoholism –In 2011, the FDA approved “Vivitrol” for the treatment of opiate addiction. An opioid receptor antagonist, that blocks the mu- opioid receptors in the brain –Mu-opioid receptors are responsible for the “high” or “buzz” individuals feel when alcohol is consumed.

6. Los Angeles County Vivitrol Pilot Project

7. Evaluation Questions 1.Willing to take multiple doses? 2.How did the Urge to Drink score change? 3.And when compared to the Post-hoc group, what proportion of the Vivitrol group: Engaged in treatment (LOS 30 days or more)? Retained in treatment (LOS 90 days or more)? Was compliant in treatment?

8. Evaluation Design No Random Assignment Alcohol only The three medication hubs –Clients went to hubs for medication and returned for psychosocial treatment Hub selection criteria: –Infrastructure to administer medications –Long-standing histories of providing quality substance abuse treatment

9. Data Collection Treatment Outcome Data –Los Angeles County Participant Reporting System (LACPRS) Outcomes, length of stay Patient Response to Vivitrol –Medically Assisted Treatment Survey (MATS) –Urge to Drink Scale (UDS)

10. Two Groups Vivitrol Group (n = 190) –Received at least one dose of medication –No random assignment – wanted medication, got medication Post-hoc Comparison Group (n = 190) –Did not receive medication –Demographics matched to Vivitrol group –Calculated propensity scores

11. Results & Findings

12. Participant Characteristics Categorical Variable Vivitrol Group (% yes) Post-hoc Group (% yes)Statistic Gender (Female)55.3%56.8%X2 = 0.096 Race/Ethnicity White African American Latino Other 41.1% 13.2% 41.1% 4.7% 43.7% 12.1% 40% 4.2% X2 = 0.323 Criminal Justice Involvement (yes)31.6%33.2%X2 =.108 Homeless status (yes)40.5%35.3%X2 = 1.118 Employment Activities (yes)10%14.2%X2 = 1.583 Program Type (Outpatient)35.3%34.7%X2 =.012 Mental Illness* (yes)44.7%32.1%X2 = 6.407 *Lifetime report of mental illness differed between groups; p<.01

13. Participant Characteristics *Days spent on the wait list significantly differed between the groups p<.001. Continuous Variable Vivitrol Group Mean (sd) Post-hoc Group Mean (sd) Test Statistic Age at Admission37.2 (9.5)36.8 (10.7)t(374) = -.469 Age at First Use17.1 (6.3)17 (6.1)t(378) = -.173 Days of Primary Drug in the Last 30 8.2 (9.5)10.2 (11.3)t(378) = 1.877 # of Prior Treatment Episodes2.2 (3.7)2 (6)t(378) = -.463 Days on Wait List*7.2 (13.6)3.7 (10.5)t(378) = -2.826 Age at Admission37.2 (9.5)36.8 (10.7)t(374) = -.469 Age at First Use17.1 (6.3)17 (6.1)t(378) = -.173

14. Reduced Urge to Drink Based on the Urge to Drink Scale, which is scored from 0 to 30.

15. Limited Side Effects Proportion Reporting Side Effect for Weeks 1 – 4 After First Dose

16. XR-NTX & Engagement Engagement = In treatment for 30+ days –Vivitrol group (96.3%) –Comparison group (72.1%) Predictors included –XR-NTX (p <.001) OR (95% CI) = 12.609 (5.178-30.706) –Age at first use (p <.05) OR (95% CI) = 1.066 (1.009-1.126)

17. XR-NTX & Retention Retention = In treatment for 90+ days –Vivitrol group (72.1%) –Comparison group (43.7%) Predictors included –XR-NTX (p <.001) OR (95% CI) = 3.868 (2.352 – 6.361) –Race (African American vs. White) (p <.05) OR (95% CI) =.380 (.175 -.826) –Mental illness diagnosis (p <.01) OR (95% CI) = 2.415 (1.370 – 4.258)

18. XR-NTX & Pos Compliance Positive Compliance = Discharge status –Vivitrol group (78.4%) –Comparison group (60%) Predictors included –XR-NTX (p <.001) OR (95% CI) = 2.766 (1.665 – 4.595) –Age at first use (p <.01) OR (95% CI) = 1.062 (1.018 - 1.109) –Employment activities (p <.01) OR (95% CI) =.318 (.134 -.755)

19. Conclusions No causal conclusions (no random assignment) Increased the number of patients who were engaged and retained in treatment and who left treatment with positive compliance Limited side effects reported by approx a quarter of patients

20. Any questions? Desiree A. Crevecoeur-MacPhail, Ph.D. desireec@ucla.edu 310-267-5207