BACKGROUND AND AIMS Criminal justice-involved individuals carry a disproportionately higher burden of opioid use disorder (OUD) than those not involved with the criminal justice system and are often unable to access opioid agonist therapies like methadone and buprenorphine. The opioid receptor antagonist naltrexone (NTX) is effective for the prevention of relapse to OUD and may be more acceptable in criminal justice settings. This objectives of this review were: (1) to provide an overall summary effect across studies for the efficacy and acceptability of oral and injectable NTX for the treatment of OUD among criminal justice involved individuals and (2) to examine systematic variations in study results to explain heterogeneity among study-specific effects. METHODS Systematic review and meta-analysis of 1045 patients across eleven studies (ten randomized controlled trials, one quasi-experimental study).. All available outcomes were pooled using random-effects meta-analysis. Subgroup analyses were conducted for oral and injectable naltrexone; meta-regression analyses were conducted for sociodemographic and study-level characteristics. RESULTS NTX improved retention in treatment (RR = 1.31; 95% CI: 1.05, 1.63), reduced rates of reincarceration (RR = 0.70 [0.54-0.92]), reduced opioid relapse (RR = 0.63 [0.53-0.76]), and improved opioid abstinence (RR = 1.38 [1.16-1.65]). While NTX was associated with a greater burden of adverse events overall (RR = 1.49 [1.13-1.95]), the findings were inconclusive as to whether or not a difference was present for the number of serious adverse events or overdoses. CONCLUSIONS Naltrexone appears to be efficacious and acceptable for the treatment of opioid use disorder among criminal justice involved individuals; however, the risk for adverse events must be weighed against the potential benefits.

中文翻译：

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纳曲酮对涉及阿片类药物使用障碍的刑事司法人员的可接受性和有效性：系统评价和荟萃分析

背景和目标 与未参与刑事司法系统的人相比，参与刑事司法的个人承受的阿片类药物使用障碍 (OUD) 负担要高得多，并且通常无法获得美沙酮和丁丙诺啡等阿片类药物激动剂疗法。阿片受体拮抗剂纳曲酮 (NTX) 可有效预防 OUD 复发，在刑事司法环境中可能更容易被接受。本综述的目的是：(1) 提供跨研究的总体总结效果，以了解口服和注射 NTX 治疗涉及刑事司法的个体的 OUD 的有效性和可接受性，以及 (2) 检查研究结果的系统变化，以解释研究特定效应之间的异质性。方法 对 11 项研究（10 项随机对照试验，1 项准实验研究）中的 1045 名患者进行系统评价和荟萃分析。使用随机效应荟萃分析汇总所有可用结果。对口服和注射纳曲酮进行了亚组分析；对社会人口统计学和研究水平特征进行了元回归分析。结果 NTX 改善了治疗保留率（RR = 1.31；95% CI：1.05, 1.63），降低了再监禁率（RR = 0.70 [0.54-0.92]），减少了阿片类药物复发（RR = 0.63 [0.53-0.76]），以及改善阿片类药物戒断（RR = 1.38 [1.16-1.65]）。虽然 NTX 总体上与更大的不良事件负担相关（RR = 1.49 [1.13-1.95]），但对于严重不良事件或过量服用的数量是否存在差异，研究结果尚无定论。结论 纳曲酮对于治疗涉及刑事司法的个人的阿片类药物使用障碍似乎是有效和可接受的；然而，必须权衡不良事件的风险与潜在益处。