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

Charles E Murphy 4th; Zlatan Coralic; Ralph C Wang; Juan Carlos C Montoy; Bianca Ramirez; Maria C Raven

doi:10.1016/j.annemergmed.2022.08.453

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

Ann Emerg Med. 2023 Apr;81(4):440-449. doi: 10.1016/j.annemergmed.2022.08.453. Epub 2022 Oct 31.

Authors

Charles E Murphy 4th¹, Zlatan Coralic², Ralph C Wang³, Juan Carlos C Montoy³, Bianca Ramirez³, Maria C Raven⁴

Affiliations

¹ Department of Emergency Medicine, University of California, San Francisco, CA. Electronic address: charles.murphyiv@ucsf.edu.
² Department of Emergency Medicine, University of California, San Francisco, CA; Department of Pharmacy, University of California, San Francisco, CA.
³ Department of Emergency Medicine, University of California, San Francisco, CA.
⁴ Department of Emergency Medicine, University of California, San Francisco, CA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.

PMID: 36328851
DOI: 10.1016/j.annemergmed.2022.08.453

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.

Trial registration: ClinicalTrials.gov NCT04094584.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Alcohol Drinking
Alcoholism* / drug therapy
Case Management
Humans
Naltrexone* / therapeutic use
Narcotic Antagonists / therapeutic use
Prospective Studies
Quality of Life

Substances

Naltrexone
Narcotic Antagonists

Associated data

ClinicalTrials.gov/NCT04094584