Extended-Release Naltrexone and Case Management for Treatment of Alcohol Use Disorder in the Emergency Department - 20/03/23

Doi : 10.1016/j.annemergmed.2022.08.453

Charles E. Murphy, MD, MAS ^a,^⁎ , Zlatan Coralic, PharmD ^a,^b, Ralph C. Wang, MD, MAS ^a, Juan Carlos C. Montoy, MD, PhD ^a, Bianca Ramirez, LCSW ^a, Maria C. Raven, MD, MPH ^a,^c
^a Department of Emergency Medicine, University of California, San Francisco, CA
^b Department of Pharmacy, University of California, San Francisco, CA
^c Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA

^∗Corresponding Author.

Abstract

Study objective

To assess the feasibility of initiating treatment for alcohol use disorder with extended-release naltrexone and case management services in the emergency department (ED) and measure the intervention’s impact on daily alcohol consumption and quality of life.

Methods

This is a 12-week prospective open-label single-arm study of a multimodal treatment for alcohol use disorder consisting of monthly extended-release naltrexone injections and case management services initiated at an urban academic ED. Participants were actively drinking adult patients in ED with known or suspected alcohol use disorder and an AUDIT-C score more than 4. The main feasibility outcomes included the rates of participant enrollment, retention in the study, and continuing treatment after study completion. Efficacy outcomes were the change in daily alcohol consumption (drinks per day; 14 g ethanol per drink), measured by a 14-day timeline followback, and the change in quality of life measured with a single-item Kemp quality of life scale.

Results

One hundred seventy-nine patients were approached, and 32 were enrolled (18%). Of the 32 enrolled patients, 25 (78%) completed all visits, and 22 (69%) continued naltrexone after the trial. The mean baseline daily alcohol consumption was 7.6 drinks per day (interquartile range, 4.5, 13.4), and the mean quality of life was 3.6 (SD 1.7) on a 7-point scale. The median daily alcohol consumption change was −7.5 drinks per day (Hodges-Lehmann 95% confidence interval −8.6, −5.9). The mean quality of life change was 1.2 points (95% confidence interval 0.5, 1.9; P<.01).

Conclusion

We found that initiation of treatment of alcohol use disorder with extended-release naltrexone and case management is feasible in an ED setting and observed significant reductions in drinking with improved quality of life in the short term. Multicenter randomized controlled trials are needed to further validate these findings.

Le texte complet de cet article est disponible en PDF.

Plan

Introduction

Materials and Methods

Study Design and Setting

Sample Size and Statistical Analysis

	Please see page 441 for the Editor’s Capsule Summary of this article.
	Supervising editors: Andrew A. Monte, MD; Richard C. Dart, MD, PhD. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: All authors contributed to the study conception and study design. CM, BR, and ZC helped collect, analyze, and interpret the data. CM, RW, JCM, MR, and ZC drafted the manuscript. All authors participated in the critical revision of the manuscript for important intellectual content. CM performed statistical analysis of the data, had full access to all of the data in the study, and takes responsibility for the paper as a whole.
	All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This research was funded by the CARESTAR foundation.
	Trial Registration Number: Clinicaltrials.gov NCT04094584.
	Readers: click on the link to go directly to a survey in which you can provide J9TXLK7 to Annals on this particular article.
	A podcast for this article is available at www.annemergmed.com.