b'Injection or Pills? How the Pandemic Affects Treatment for Veterans With Substance-Use Disordersthe median time to relapse in veterans withalcohol-usedisorderfrom50.5 daysfororalnaltrexonetomorethan 150days. 1 Theresearchersconcluded thatlong-actinginjectablenaltrexone should be considered the first-line option for these patients, though they called for larger randomized controlled studies to confirm their results.The study authors noted that the life-time prevalence of alcohol-use disorder is 42.2% in veterans and 39% of patients whoseektreatmentdiscontinuetheir medication and relapse. Thefindingsmatchupwithwhatdemonstratedsuperiorityofinjectableto enroll 900 veterans over a three-year Saxon has seen in practice. naltrexonetotheoralformulationforperiod.ParticipantsintheVA-BRAVE Theclinicalexperienceisthat,forthosewithopioidaddiction. 2 Patientsstudywillbeactivelyfollowedfor52 patients who have a hard time taking oralreceivingthelong-actingnaltrexoneweeks to assess any differences in retain-medications or dont get as good a response,injection have also already gone throughing veterans in opioid treatment and in the injection is better, Saxon explained. a detox period of at least seven days. sustaining opioid abstinence. InjectableshavetwosignificantAnother mainstay of opioid therapy,It takes three years or more to plan advantages.Theobviousoneisthatbuprenorphine, is also available as antheselargestudies.Itsfrustratingto the patient doesnt have to worry aboutinjectable that lasts 30 days. The piv- applythebrakeswhenwereonthe taking medications on a daily basis, heotal randomized controlled trial (RCT)verge of starting a really major study, said.Thepharmacokineticreasonisfor that injectable compared it to pla- but were on hold now because of the that injectables provide a steady bloodceboratherthanthecommonlyusedpandemic, Saxon said. plasmaleveland,therefore,patientssublingualformulationwhichcom- The pandemic has not blocked patients experienceamorestablebrainlevelbines buprenorphine with naloxone towhoneedinjectionsfromreceiving that with transmucosal or oral formula- minimize its potential for abuse.them at the VA Puget Sound, though. tions that have peaks and valleys. A second buprenorphine injectable forWevehadverygoodresultswith Thosefactorsmightcontributetoopioid-usedisorderwillcomeonthe30 patients who are doing very well on better outcomes for veterans. We cer- market in December. Made by the sameinjections,andmosthavedecidedto tainlyseesomepatientsthatrespondcompany that produces the buprenor- continue them through the pandemic, better to injectables, with better trajec- phineimplant,itwillprovidebothsaid Saxon. Our brave and heroic staff toriesforrecoveryfromalcohol-useseven-dayand30-dayoptions.Thewant to take care of our patients and disorder, Saxon said. RCT on which the U.S. Food and Drugour nurses are willing to give patients Administrationreliedforapprovalofthese injections. o pioid -u sed isorder the new drug found it superior to sub- 1 Leighty AE, Ansara ED. Treatment outcomes The calculation is a little different forlingual buprenorphine, Saxon noted. of long-acting injectable naltrexone versus oral patients on injectable medications forThe pandemic has disrupted both carenaltrexone in alcohol-use disorder in veterans. opioid-use disorder. for current patients with substance-useMent Health Clin. 2019;9(6):392-396. Published Youll want to continue injectablesdisorders, as well as research into the2019 Nov 27. doi:10.9740/mhc.2019.11.392if a patient is on them for opioid-usebest options for their ongoing treatment. Sullivan MA, Bisaga A, Pavlicova M, et al. A disorder even during this time becauseSaxon noted with disappointment thatRandomized Trial Comparing Extended-Re-they have been shown to be more effec- the VA had just funded an RCT compar- lease Injectable Suspension and Oral Naltrex-tivethanoralmedications,Saxoning long-acting injectable buprenorphineone, Both Combined With Behavioral Therapy, for the Treatment of Opioid Use Disorder. Am J pointed out. to daily sublingual buprenorphine that hasPsychiatry. 2019;176(2):129-137. doi:10.1176/Arandomizedcontrolledtrialhasbeen put on pause. The trial is expectedappi.ajp.2018.17070732382020 COMPENDIUM OF FEDERAL MEDICINE'