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Naltrexone for Opioid Use Disorders: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Published on: July 4, 2017
Project Number: RC0904-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of naltrexone formulations for the treatment of patients with opioid use disorders?
  2. What is the cost-effectiveness of naltrexone formulations for the treatment of patients with opioid use disorders?
  3. What are the evidence-based guidelines associated with naltrexone formulations for the treatment of patients with opioid use disorders?

Key Message

Extended release injectable naltrexone (XR-NTX) was favoured relative to placebo, treatment as usual or buprenorphine for abstinence duration and treatment retention outcomes. Oral naltrexone was not generally found to improve the duration of abstinence, though may be helpful to assist in induction onto XR-NTX. Safety outcomes were not found to be different among treatment versus comparator groups.The balance of evidence suggests XR-NTX may be cost-effective relative to methadone and buprenorphine treatment depending on the willingness-to-pay. The cost-effectiveness of oral naltrexone and buprenorphine treatments was similar on almost all primary outcomes.Guidelines generally recommended naltrexone if other treatments were contraindicated, or if patients had demonstrated sustained abstinence. Guidelines published since 2015 specifically do not recommend oral naltrexone, but XR-NTX was recommended if adherence issues were a concern or if agonist treatment could not be used.

Tags

rehabilitation, naltrexone, narcotic antagonists, opioid-related disorders, addiction, Narcotic, Narcotics, Opiate, Opiates, Addiction, drug abuse, drug addiction