Extended-release naltrexone — an FDA-approved treatment for opioid use disorder — may improve treatment outcomes for HIV-positive people released from prison or jail who have a history of opioid addiction, according to a new study by Yale researchers.
Set to be published in the Journal of Acquired Immune Deficiency Syndromes on May 1, the study found that recently released prisoners and jail detainees who received extended-release naltrexone were more likely to maintain or improve their HIV viral load suppression, a measure of whether a patient is taking HIV-suppressing drugs. The research may inform treatment for opioid use disorder and HIV in and out of prison, according to professor at the School of Medicine and co-lead author Sandra Ann Springer.
“One of the biggest implications is that for prisoners and jail detainees, who have the highest rates of opioid use disorder and HIV in the country, we shouldn’t be waiting,” Springer said. “We should be offering opioid-use disorder treatment before they get released.”
The period of time right when incarcerated people leave prison is incredibly chaotic — and is associated with opioid overdose and loss of HIV care, explained Frederick Altice, professor at the medical school and co-lead author of the study. The researchers’ findings suggest that preventing opioid use disorder relapse can provide a stabilizing force that allows people to remain engaged in HIV care during the tumultuous time, he said.
In the study, incarcerated people were given either the drug or a placebo during the transition back to their communities. Following 93 people for six months each between 2010 and 2016, the researchers found that a greater proportion of the people who received extended-release naltrexone ended up getting HIV treatment as well.
“This is the first study to show in a randomized, double-blinded control trial that an FDA-approved medication used to treat opioid use disorder — naltrexone — can improve viral load suppression,” Springer said.
Previously, Springer’s lab performed a study that obtained similar results using buprenorphine, another opioid-use disorder medication. However, this research, published in PLOS One in 2012, was a nonrandomized control trial, she said.
The study authors said their findings suggest a greater need for implementation of medication-assisted treatments, such as naltrexone and buprenorphine, in prison settings.
“In this study, we are specifically talking about people who are living with HIV, but because of the opioid epidemic, we should be screening everybody [in prison] for opioid use disorder and instantly providing medication to prevent relapse,” Springer said.
Springer said the guidelines from organizations that provide HIV treatment recommendations — the Department of Health and Human Services, the World Health Organization and the International AIDS Society — should also include the use of medication to prevent opioid use as a method to maintain viral load suppression for people who also have opioid-use disorder.
Altice said that policies and funding priorities also need to change in order to implement treatment delivery in prison and to develop more effective transitional programs.
“One of the problems with implementation is that on average, going from an evidence-based intervention to actual practice takes 17 years,” Altice said. “We can’t wait 17 years and allow unnecessary consequences to happen for people because of the delay in implementation.”
Springer said she hopes to continue this research by studying other forms of medication for opioid-use disorder, such as buprenorphine and methadone and potentially investigating whether there are differences among the medications.
The researchers will soon publish a separate study about the use of the same naltrexone medication — but for HIV-positive people who have alcohol-use disorder and are coming out of prison or jail. Similar to the current study, those who received treatment for alcoholism maintained or improved their viral load suppression, Springer added.
The study was funded by a grant from the National Institute on Drug Abuse.
I think treatment with Buprenorphine will be superior to Naltrexone alone.