A demonstration project implementing extended-release naltrexone in Los Angeles County.

BACKGROUND: Extended-released naltrexone (XR-NTX) is a Food and Drug Administration (FDA)-approved medication associated with higher rates of abstinence, reduced cravings, and delayed relapse to use. However, there is a dearth of literature on real-world implementation of XR-NTX. The Los Angeles County Department of Public Health, in collaboration with UCLA Integrated Substance Abuse Programs, developed a demonstration project to increase access to XR-NTX. This article describes that project, along with data on the expansion of XR-NTX service delivery and patient uptake. METHODS: A secondary descriptive data analysis of demographics, substance use history, current substance use behaviors, health-related variables, and dosing records was conducted on 609 patients who received XR-NTX from Los Angeles County substance use disorder (SUD) treatment facilities from April 2010 through July 2013. A geographic information system approach mapped the distribution of XR-NTX-referring agencies across Los Angeles County. RESULTS: Of the 609 records analyzed, a majority of patients (64%) obtained more than 1 dose of XR-NTX. Most XR-NTX patients reported alcohol use disorder (71.9%; n = 438). Compared with the general Los Angeles County substance use disorder patients, XR-NTX recipients reported more severe substance use histories. Finally, XR-NTX was accessed by providers in 6 of the 8 Service Planning Areas of Los Angeles County. CONCLUSIONS: These findings reflect a higher XR-NTX cessation rate and a lower average number of doses, in contrast to similar demonstration projects in community settings with patients on parole or probation. However, this study shows that it is feasible to engage treatment providers in the use XR-NTX among their patients with alcohol or opioid use disorders. Several implications for future research and implementation are discussed.

Inside the black box: measuring addiction treatment services and their relation to outcomes.

The adoption of performance-based management has been under consideration by addiction treatment funding agencies, and, recently, many state and county agencies have developed performance-based measurement/management systems in an attempt to improve their treatment system. This article describes one such effort in Los Angeles County, California. The Performance-Based Pilot Project linked treatment encounters (counseling sessions, drug testing, case management, and methadone dosing) with client outcomes (abstinence or reduced drug use at discharge) and longer lengths of stay in treatment. Eleven outpatient counseling programs and three narcotic treatment programs participated in the nine-month project. Results indicated that for both outpatient counseling and narcotic treatment programs, more sessions attended in the first 30 days was associated with better client outcomes and longer lengths of stay. Furthermore, in outpatient counseling programs, more group sessions during the first 30 days predicted abstinence or greater reductions in primary drug use; in narcotic treatment programs, more doses received during the first 30 days was correlated to longer treatment retention. This research implies that increasing the availability of counseling sessions for a client's first 30 days and engaging clients early is a promising area for program efforts to improve treatment outcomes and program performance.

Improving client engagement and retention in treatment: the Los Angeles County experience.

This article discusses a two-phase demonstration project focused on the implementation of the Network for the Improvement of Addiction Treatment model of process improvement among substance abuse treatment providers in Los Angeles County, California. A total of 30 Change Teams from 12 county-contracted treatment agencies planned and executed one or more rapid-cycle change projects to reduce wait time to treatment, reduce no-shows to scheduled appointments, increase admissions, or improve continuation in treatment. The findings and lessons learned illustrate the importance of a concrete and straightforward methodology and consistent peer-to-peer interaction provided in a learning collaborative environment. In addition, both ongoing technical assistance and coaching are essential for successful implementation of this innovative, low-cost, evidence-based process improvement strategy.