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Naltrexone to reduce criminal activity (re-incarceration) and improve treatment outcomes in drug-using offenders
Summary of the evidence
Naltrexone (NTX), an antagonist pharmacological treatment for relapse prevention, reversibly blocks reward associated with opioid use, without possessing any opioid-like properties of its own. Extended-release NTX is available and administered through intramuscular injections every 4 weeks, eliminating the need for daily oral dosing.
Naltrexone was found in a systematic review wit meta-analysis (Bahji et al., 2020, 11 studies, N= 1 045) to be effective in:
- improving retention in treatment (RR = 1.31; 95% confidence interval (CI) = 1.05, 1.63) - no difference between oral and extended release
- reducing rates of re-incarceration (RR = 0.70, 95% CI = 0.54–0.92) - significant reduction for oral NTX
- reducing opioid relapse (RR = 0.63, 95% CI = 0.53–0.76) - no difference between oral and extended release
- and improved opioid abstinence (RR = 1.38, 95% CI = 1.16–1.65) - significant reduction for extended release NTX
However, Naltrexone was associated with a greater burden of adverse events overall (RR = 1.49, 95% CI = 1.13–1.95). Mild to moderate adverse events were more frequently reported by participants receiving extended release -NTX (rather than oral NTX) compared to TAU conditions, and these included dry mouth, colic, fatigue, anxiety, blurred vision, abdominal pain, vomiting, nausea and insomnia. The most common reported side effects with extended release-NTX were immediate injection site reactions (such as redness and soreness) and fatigue.
Serious adverse events (i.e. requiring discontinuation or hospitalization) were not statistically significant higher among those who received Naltrexone.
