TY - JOUR
KW - Adult
KW - Analgesics, Opioid/therapeutic use
KW - Buprenorphine/therapeutic use
KW - Continuity of Patient Care/organization & administration
KW - Delayed-Action Preparations
KW - Female
KW - Health Services Accessibility
KW - Humans
KW - Interviews as Topic
KW - Male
KW - Methadone/therapeutic use
KW - Middle Aged
KW - Naltrexone/therapeutic use
KW - Opiate Substitution Treatment/methods/psychology
KW - Opioid-Related Disorders/drug therapy
KW - Patient Satisfaction
KW - Prisoners/psychology
KW - Qualitative Research
KW - Socioeconomic Factors
KW - Extended-release naltrexone
KW - Incarceration
KW - opioid use disorder
KW - Reentry
AU - M. Velasquez
AU - M. Flannery
AU - R. Badolato
AU - A. Vittitow
AU - R. D. McDonald
AU - B. Tofighi
AU - A. R. Garment
AU - J. Giftos
AU - J. D. Lee
A1 - 
AB - BACKGROUND: Few studies have documented patient attitudes and experiences with extended-release naltrexone (XR-NTX) opioid relapse prevention in criminal justice settings. This study assessed barriers and facilitators of jail-to-community reentry among adults with opioid use disorder (OUD) treated with XR-NTX, buprenorphine, methadone, and no medications. METHODS: This qualitative study conducted individual interviews with a purposeful and convenience sample of adults with OUD who were recently released from NYC jails. XR-NTX, no medication, and methadone participants were concurrently enrolled in a large randomized controlled trial evaluating XR-NTX vs. a no medication Enhanced Treatment As Usual (ETAU) condition, or enrolled in a non-randomized quasi-experimental methadone maintenance cohort. Buprenorphine participants were referred from NYC jails to a public hospital office-based buprenorphine program and not enrolled in the parent trial. Interviews were audio recorded, transcribed, independently coded by two researchers, and analyzed per a grounded theory approach adapted to the Social Cognitive Theory framework. The research team reviewed transcripts and coding to reach consensus on emergent themes. RESULTS: N = 33 adults with OUD (28 male, 5 female) completed a single individual interview. Purposeful sampling recruited persons leaving jail on XR-NTX (n = 11), no active medication treatment (n = 9), methadone (n = 9), and buprenorphine (n = 4). Emergent themes were: (1) general satisfaction with XR-NTX's long-acting antagonist effects and control of cravings; (2) "testing" XR-NTX's blockade with heroin upon reentry was common; (3) early discontinuation of XR-NTX treatment was most common among persons with high self-efficacy and/or heavy exposure to drug use environments and peers; (4) similar satisfaction regarding effects of methadone and buprenorphine maintenance among retained-in-treatment individuals, alongside general dissatisfaction with daily observed dosing requirements and misinformation and stigmas regarding methadone adverse effects; (5) unstable housing, economic insecurity, and exposure to actively using peers were attributed to early termination of treatment and relapse; (6) individual motivation and willpower as central to long-term opioid abstinence and reentry success. CONCLUSIONS: In the context of more familiar agonist maintenance treatments, XR-NTX relapse prevention during jail-to-community reentry was viewed as a helpful and unique intervention though with important limitations. Commonly described barriers to treatment retention and heroin abstinence included homelessness, economic insecurity, and drug-using peers. Trial registration ClinicalTrials.gov, NCT01999946 (XOR), Registered 03 December 2013, https://clinicaltrials.gov/ct2/show/NCT01999946 .
AD - Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.; Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.; Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.; Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.; Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.; Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.; Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.; Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.; Correctional Health Services, New York City Health + Hospitals Corporation, 55 Water Street, New York, NY, 10041, USA.; Department of Population Health, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA. Joshua.lee@nyulangone.org.; Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA. Joshua.lee@nyulangone.org.; New York University School of Medicine, 180 Madison Avenue, 17th Floor, 1714, New York, NY, 10016, USA. Joshua.lee@nyulangone.org.
BT - Addiction science & clinical practice
C5 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
CP - 1
DO - 10.1186/s13722-019-0166-0
IS - 1
JF - Addiction science & clinical practice
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Few studies have documented patient attitudes and experiences with extended-release naltrexone (XR-NTX) opioid relapse prevention in criminal justice settings. This study assessed barriers and facilitators of jail-to-community reentry among adults with opioid use disorder (OUD) treated with XR-NTX, buprenorphine, methadone, and no medications. METHODS: This qualitative study conducted individual interviews with a purposeful and convenience sample of adults with OUD who were recently released from NYC jails. XR-NTX, no medication, and methadone participants were concurrently enrolled in a large randomized controlled trial evaluating XR-NTX vs. a no medication Enhanced Treatment As Usual (ETAU) condition, or enrolled in a non-randomized quasi-experimental methadone maintenance cohort. Buprenorphine participants were referred from NYC jails to a public hospital office-based buprenorphine program and not enrolled in the parent trial. Interviews were audio recorded, transcribed, independently coded by two researchers, and analyzed per a grounded theory approach adapted to the Social Cognitive Theory framework. The research team reviewed transcripts and coding to reach consensus on emergent themes. RESULTS: N = 33 adults with OUD (28 male, 5 female) completed a single individual interview. Purposeful sampling recruited persons leaving jail on XR-NTX (n = 11), no active medication treatment (n = 9), methadone (n = 9), and buprenorphine (n = 4). Emergent themes were: (1) general satisfaction with XR-NTX's long-acting antagonist effects and control of cravings; (2) "testing" XR-NTX's blockade with heroin upon reentry was common; (3) early discontinuation of XR-NTX treatment was most common among persons with high self-efficacy and/or heavy exposure to drug use environments and peers; (4) similar satisfaction regarding effects of methadone and buprenorphine maintenance among retained-in-treatment individuals, alongside general dissatisfaction with daily observed dosing requirements and misinformation and stigmas regarding methadone adverse effects; (5) unstable housing, economic insecurity, and exposure to actively using peers were attributed to early termination of treatment and relapse; (6) individual motivation and willpower as central to long-term opioid abstinence and reentry success. CONCLUSIONS: In the context of more familiar agonist maintenance treatments, XR-NTX relapse prevention during jail-to-community reentry was viewed as a helpful and unique intervention though with important limitations. Commonly described barriers to treatment retention and heroin abstinence included homelessness, economic insecurity, and drug-using peers. Trial registration ClinicalTrials.gov, NCT01999946 (XOR), Registered 03 December 2013, https://clinicaltrials.gov/ct2/show/NCT01999946 .
PY - 2019
SN - 1940-0640; 1940-0632; 1940-0632
SP - 019
EP - 0
EP - 37+
T1 - Perceptions of extended-release naltrexone, methadone, and buprenorphine treatments following release from jail
T2 - Addiction science & clinical practice
TI - Perceptions of extended-release naltrexone, methadone, and buprenorphine treatments following release from jail
U1 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
U2 - 31570100
U3 - 10.1186/s13722-019-0166-0
VL - 14
VO - 1940-0640; 1940-0632; 1940-0632
Y1 - 2019
Y2 - Oct 1
ER -