Trial reportThe American journal of psychiatry2021
Sublingual Buprenorphine-Naloxone Compared With Injection Naltrexone for Opioid Use Disorder: Potential Utility of Patient Characteristics in Guiding Choice of Treatment.
Trial report in The American journal of psychiatry, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 34 citations in OpenAlex.
- Opioid agonist treatment for people who are dependent on pharmaceutical opioids.The Cochrane database of systematic reviews · 2022Pooled it
- Beneficial effects of the rapid vs. standard procedure for injection naltrexone initiation operate through increased adjunctive medication use.Drug and alcohol dependence · 2026Trial
- Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone on treatment interruption: Comparing findings from a reanalysis of the X:BOT RCT and harmonized target trial emulation using population-based observational data.Addiction (Abingdon, England) · 2025Trial
- Buprenorphine-naloxone vs. extended-release naltrexone for opioid use disorder in individuals with and without criminal legal involvement: A secondary analysis of the X:BOT randomized controlled trial.Journal of substance use and addiction treatment · 2024Trial
- Extended-Release Injection vs Sublingual Buprenorphine for Opioid Use Disorder With Fentanyl Use: A Post Hoc Analysis of a Randomized Clinical Trial.JAMA network open · 2024Trial
- Association between dynamic dose increases of buprenorphine for treatment of opioid use disorder and risk of relapse.Addiction (Abingdon, England) · 2022Trial
- Optimizing opioid use disorder treatment with naltrexone or buprenorphine.Drug and alcohol dependence · 2021Trial
- Examination of Correlates of OUD Outcomes in Young Adults: Secondary Analysis From the XBOT Trial.The American journal on addictions · 2021Trial
- Machine Learning-Driven Analysis of Individualized Treatment Effects Comparing Buprenorphine and Naltrexone in Opioid Use Disorder Relapse Prevention.Journal of addiction medicineTrial
- Harm reduction engagement and ongoing opioid use among adults receiving methadone or buprenorphine in Philadelphia.Harm reduction journal · 2026Article
- Transporting Results from a Trial to an External Target Population When Trial Participation Impacts Adherence.Epidemiology (Cambridge, Mass.) · 2026Article
- Article
- Medications for opioid use disorder: Predictors of early discontinuation and reduction of overdose risk in US military veterans by medication type.Addiction (Abingdon, England) · 2025Article
- Comparative effectiveness of extended-release naltrexone and sublingual buprenorphine for treatment of opioid use disorder among Medicaid patients.Addiction (Abingdon, England) · 2024Observational
- Enhancing translation: A need to leverage complex preclinical models of addictive drugs to accelerate substance use treatment options.Pharmacology, biochemistry, and behavior · 2024Review
- Comparative effectiveness of extended release naltrexone and sublingual buprenorphine for treatment of opioid use disorder among Medicaid patients.medRxiv : the preprint server for health sciences · 2024Article
- The relationship between reincarceration and treatment of opioid use disorder with extended-release naltrexone among persons with HIV.Drug and alcohol dependence reports · 2023Article
- Optimally Choosing Medication Type for Patients With Opioid Use Disorder.American journal of epidemiology · 2023Article
- Buprenorphine & methadone dosing strategies to reduce risk of relapse in the treatment of opioid use disorder.Drug and alcohol dependence · 2022Article
- Flexible Buprenorphine/Naloxone Treatment Models: Safe and Effective in Reducing Opioid Use Among Persons With Prescription Opioid Use Disorder.The American journal of psychiatry · 2022Article
Corrections and comments
- Commented on by
Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
objectiveSublingual buprenorphine-naloxone and extended-release injection naltrexone are effective treatments, with distinct mechanisms, for opioid use disorder. The authors examined whether patients' demographic and clinical characteristics were associated with better response to one medication or the other.
methodsIn a multisite 24-week randomized comparative-effectiveness trial of assignment to buprenorphine-naloxone (N=287) compared with extended-release naltrexone (N=283) comprising inpatients planning to initiate medication treatment for opioid use disorder, 50 demographic and clinical characteristics were examined as moderators of the effect of medication assignment on relapse to regular opioid use and failure to initiate medication. Moderator-by-medication interactions were estimated using logistic regression with correction for multiple testing.
resultsIn the intent-to-treat sample, patients who reported being homeless had a lower relapse rate if they were assigned to receive extended-release naltrexone (51.6%) compared with buprenorphine-naloxone (70.4%) (odds ratio=0.45, 95% CI=0.22, 0.90); patients who were not homeless had a higher relapse rate if they were assigned to extended-release naltrexone (70.9%) compared with buprenorphine-naloxone (53.1%) (odds ratio=2.15, 95% CI=1.44, 3.21). In the subsample of patients who initiated medication, the interaction was not significant, with a similar pattern of lower relapse with extended-release naltrexone (41.4%) compared with buprenorphine (68.6%) among homeless patients (odds ratio=0.32, 95% CI=0.15, 0.68) but less difference among those not homeless (extended-release naltrexone, 57.2%; buprenorphine, 52.0%; odds ratio=1.24, 95% CI=0.80, 1.90). For failure to initiate medication, moderators were stated preference for medication (failure was less likely if the patient was assigned to the medication preferred), parole and probation status (fewer failures with extended-release naltrexone for those on parole or probation), and presence of pain and timing of randomization (more failure with extended-release naltrexone for patients endorsing moderate to severe pain and randomized early while still undergoing medically managed withdrawal).
conclusionsAmong patients with opioid use disorder admitted to inpatient treatment, homelessness, parole and probation status, medication preference, and factors likely to influence tolerability of medication initiation may be important in matching patients to buprenorphine or extended-release naltrexone.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.