Naltrexone XR (XR-NTX) Can Be Used to Support Hepatitis C Virus (HCV) Treatment In Young Medically Withdrawn Persons Who Inject Drugs (PWIDs) – A Preliminary Report


Author: Seneca KH, Homer R, and Nahass RG

Theme: Models of Care Year: 2019

Background:
Opioid use disorder (OUD) affects 2 million persons worldwide. 50% may have HCV infection.
Treatment with methadone and suboxone, are well-studied options in PWIDs. XR-NTX is less
studied, especially in young PWIDs who recently had medically supervised withdrawal. We report a
model of care with concurrent co-located treatment of OUD, using XR-NTX, and HCV in young
PWIDs.
Description of model of care/intervention:
Persons age 18-35 were identified at acute hospitals and sober living homes with OUD and HCV.
Informed consent was obtained from patients to be treated concurrently with XR-NTX and HCV
treatment. An APN and addiction certified social worker performed co-located bi-monthly visits
where medications, medical care and counselling were provided. Weekly telephone encounters
occurred. Transportation barriers were limited by coordination with the state insurance medical
benefit, LogistiCare or Uber. XR-NTX injection adverse effects were documented. Abstinence was
assessed by patient’s account and urine drug screens (UDS). Visual analog scale (VAS) recorded
cravings.
Effectiveness:
2/17 enrollees were ineligible. 29 years was mean age of 15 enrollees. 53% were female. 94% were
non-Hispanic white. 60% (9) received more than one XR-NTX administration. For those on treatment,
UDS were negative 91% of visits for opioids. Patients reported abstinence 88% of the time. VAS
craving scores averaged 17 prior to XR-NTX and 5 by month 3. Despite an average ALT of 93 (range
31-301) no adverse effects on liver or generally were noted in patients receiving XR-NTX. 10/15
(60%) were retained in care. To date, 6/15 have been cured of HCV. To be updated at the
presentation.
Conclusion and next steps:
XR-NTX is a useful treatment in young persons who had recent withdrawal management as part of a
multidisciplinary integrated model of care to treat HCV as evidenced by abstinence, opioid cravings
and ongoing engagement in care.
Disclosure of Interest Statement:
Dr. Nahass has received grant funding from AbbVie, Alkermes, Merck, Gilead, ViiV; has conducted
speaking and/or advisory activities for Merck, AbbVie, Gilead. Pharmaceutical grant from AbbVie
and Alkermes was received in the development of this study.
Kathleen Seneca has conducted speaking activities for Merck and AbbVie.

Download abstract Download Poster