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Pre-Release VIVITROL for Opioid Dependent Inmates

Primary Purpose

Substance-Related Disorders

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
naltrexone for extended release injectable suspension
Sponsored by
Rhode Island Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Substance-Related Disorders

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Incarcerated adults with known release date.
  2. Meet DSM-IV criteria for current (and/or prior to incarceration) opioid dependence.
  3. Not interested in agonist (methadone, buprenorphine) treatment.
  4. Currently opioid free by history ('detoxed'), with negative urine for all opioids and no sign of opiate withdrawal after IV (or IM if no available venous access) injection of 0.8 mg naloxone.
  5. Good health by medical history, physical examination and laboratory tests.
  6. Age older than 18.
  7. Understands and signs a consent form.
  8. Able to speak and understand English.
  9. Females: not pregnant (urine hCG negative at baseline and prior to each injection), not planning conception; and planning appropriate contraception if sexually active.

Exclusion Criteria:

  1. Current drug or alcohol dependence requiring long term residential treatment that would interfere with outpatient study participation. Dependence on substances that commonly co-occur with opioid dependence (e.g. cocaine, cannabis, alcohol) that do not rise to this level of severity will not be exclusionary in order to achieve a maximally representative sample.
  2. Liver failure and/or liver function test levels greater than three times normal.
  3. Pregnancy, lactation, or failure to use adequate contraceptive methods;
  4. Active medical illness that might make participation hazardous, e.g. untreated hypertension, hepatitis with AST or ALT > 3 times upper limit of normal, unstable diabetes or heart disease. Adequately treated medical conditions are acceptable.
  5. Untreated psychiatric disorder that might make participation hazardous, e.g. untreated psychosis, bipolar disorder with mania, significant suicide risk. Adequately treated psychiatric disorders and appropriate psychotropic medications would be allowed.
  6. History of allergic reaction to naltrexone;
  7. Current chronic pain diagnosis for which opioids are required for pain relief.
  8. Obesity (BMI of 40 or greater) to reduce the likelihood of injection site reaction.
  9. Known intolerance and/or hypersensitivity to naltrexone, carboxymethylcellulose, or polylactide-co-polymers (PLG) or any other components of the diluents.

Sites / Locations

  • Rhode Island Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

PRE-release XR-NTX

POST-release XR-NTX

Arm Description

Participants randomly assigned to the pre-release condition will receive one injection of XR-NTX 1-2 weeks prior to prison release plus up to five additional injections of XR-NTX in the community after release

Participant randomly assigned to the post-release group will be referred to Rhode Island Hospital to receive up to six injections of XR-NTX immediately after release from prison

Outcomes

Primary Outcome Measures

Proportion of opioid-free days

Secondary Outcome Measures

Full Information

First Posted
March 23, 2012
Last Updated
October 21, 2015
Sponsor
Rhode Island Hospital
Collaborators
National Institute on Drug Abuse (NIDA), Alkermes, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT01563718
Brief Title
Pre-Release VIVITROL for Opioid Dependent Inmates
Official Title
VIVITROL® (Naltrexone for Extended Release Injectable Suspension (XR-NTX)) for Opioid Dependent Inmates Released From Prison
Study Type
Interventional

2. Study Status

Record Verification Date
October 2015
Overall Recruitment Status
Completed
Study Start Date
March 2012 (undefined)
Primary Completion Date
August 2015 (Actual)
Study Completion Date
August 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Rhode Island Hospital
Collaborators
National Institute on Drug Abuse (NIDA), Alkermes, Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Naltrexone is a medication that has been shown to help prevent relapse to opioid addiction and it has been reported to be clinically effective in parolee populations although it is rarely used. Recently a depot formulation with one-month duration has received FDA approval for the treatment of alcoholism and opiate dependence. This means that rather than having to take medication daily, individuals can receive one injection that lasts for approximately 30 days. The purpose of this study is to determine whether this monthly injection of naltrexone is practical and useful in the prevention of relapse to opioids and re-incarceration when administered to inmates prior to release from prison. The investigators will also monitor HIV risk behaviors to determine whether the intervention reduces risky behaviors associated with intravenous drug abuse and the spread of viruses such as HIV and hepatitis C. Volunteers will be randomized to receive an injection of depot naltrexone prior to release from prison or to contact study personnel in the community following release. Participants assigned to receive naltrexone in prison will receive 1 injection in prison, and 5 additional monthly injections for 5 months upon release. Participants assigned to contact study personnel upon release will receive all 6 injections in the community at RIH after their release from the ACI. Patients in both groups will be given identical follow up monthly for six months including measures of opiate use by self-report, and urine tests. An additional scheduled urine test will take place each month between monthly visits. There will also be a 12-month follow-up period for participants in both groups, which will consist of 2 visits, spaced 6 months apart, meaning that participants will be enrolled in the study for a total of about 18 months. All participants will be asked to complete brief questionnaires at follow-up visits to assess things such as services received, drug use, and depression.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Substance-Related Disorders

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
26 (Actual)

8. Arms, Groups, and Interventions

Arm Title
PRE-release XR-NTX
Arm Type
Experimental
Arm Description
Participants randomly assigned to the pre-release condition will receive one injection of XR-NTX 1-2 weeks prior to prison release plus up to five additional injections of XR-NTX in the community after release
Arm Title
POST-release XR-NTX
Arm Type
Active Comparator
Arm Description
Participant randomly assigned to the post-release group will be referred to Rhode Island Hospital to receive up to six injections of XR-NTX immediately after release from prison
Intervention Type
Drug
Intervention Name(s)
naltrexone for extended release injectable suspension
Other Intervention Name(s)
VIVITROL
Intervention Description
VIVITROL (naltrexone for extended-release injectable suspension) is supplied as a microsphere formulation of naltrexone for suspension, at a dose of 4cc (380mg of naltrexone base), administered by intramuscular injection to the buttocks (alternating sides monthly) for six months.
Primary Outcome Measure Information:
Title
Proportion of opioid-free days
Time Frame
18 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Incarcerated adults with known release date. Meet DSM-IV criteria for current (and/or prior to incarceration) opioid dependence. Not interested in agonist (methadone, buprenorphine) treatment. Currently opioid free by history ('detoxed'), with negative urine for all opioids and no sign of opiate withdrawal after IV (or IM if no available venous access) injection of 0.8 mg naloxone. Good health by medical history, physical examination and laboratory tests. Age older than 18. Understands and signs a consent form. Able to speak and understand English. Females: not pregnant (urine hCG negative at baseline and prior to each injection), not planning conception; and planning appropriate contraception if sexually active. Exclusion Criteria: Current drug or alcohol dependence requiring long term residential treatment that would interfere with outpatient study participation. Dependence on substances that commonly co-occur with opioid dependence (e.g. cocaine, cannabis, alcohol) that do not rise to this level of severity will not be exclusionary in order to achieve a maximally representative sample. Liver failure and/or liver function test levels greater than three times normal. Pregnancy, lactation, or failure to use adequate contraceptive methods; Active medical illness that might make participation hazardous, e.g. untreated hypertension, hepatitis with AST or ALT > 3 times upper limit of normal, unstable diabetes or heart disease. Adequately treated medical conditions are acceptable. Untreated psychiatric disorder that might make participation hazardous, e.g. untreated psychosis, bipolar disorder with mania, significant suicide risk. Adequately treated psychiatric disorders and appropriate psychotropic medications would be allowed. History of allergic reaction to naltrexone; Current chronic pain diagnosis for which opioids are required for pain relief. Obesity (BMI of 40 or greater) to reduce the likelihood of injection site reaction. Known intolerance and/or hypersensitivity to naltrexone, carboxymethylcellulose, or polylactide-co-polymers (PLG) or any other components of the diluents.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Peter D Friedmann, MD, MPH
Organizational Affiliation
Rhode Island Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Rhode Island Hospital
City
Providence
State/Province
Rhode Island
ZIP/Postal Code
02903
Country
United States

12. IPD Sharing Statement

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Pre-Release VIVITROL for Opioid Dependent Inmates

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