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The opioid receptor antagonist naltrexone (NTX) is effective for the prevention of relapse to OUD and may be more acceptable in criminal justice settings. The objectives of this review were to: (1) 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\u2010involved individuals and (2) examine systematic variations in study results to explain heterogeneity among study\u2010specific effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Systematic review and meta\u2010analysis of 1045 patients across 11\u00a0studies (10 randomized controlled trials, one quasi\u2010experimental study). All available outcomes were pooled using random\u2010effects meta\u2010analysis. Subgroup analyses were conducted for oral and injectable naltrexone; meta\u2010regression analyses were conducted for socio\u2010demographic and study\u2010level characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>NTX improved retention in treatment [risk ratio (RR)\u00a0=\u00a01.31; 95% confidence interval (CI)\u00a0=\u00a01.05, 1.63], reduced rates of re\u2010incarceration (RR\u00a0=\u00a00.70, 95% CI\u00a0=\u00a00.54\u20130.92), reduced opioid relapse (RR\u00a0=\u00a00.63, 95% CI\u00a0=\u00a00.53\u20130.76) and improved opioid abstinence (RR\u00a0=\u00a01.38, 95% CI\u00a0=\u00a01.16\u20131.65). While NTX was associated with a greater burden of adverse events overall (RR\u00a0=\u00a01.49, 95% CI\u00a0=\u00a01.13\u20131.95), the findings were inconclusive as to whether or not a difference was present for the number of serious adverse events or overdoses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Naltrexone appears to be efficacious and acceptable for the treatment of opioid use disorder among criminal justice\u2010involved individuals; however, the risk for adverse events must be weighed against the potential benefits.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.14946","type":"journal-article","created":{"date-parts":[[2019,12,21]],"date-time":"2019-12-21T15:04:46Z","timestamp":1576940686000},"page":"1413-1425","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Acceptability and efficacy of naltrexone for criminal justice\u2010involved individuals with opioid use disorder: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3490-314X","authenticated-orcid":false,"given":"Anees","family":"Bahji","sequence":"first","affiliation":[{"name":"Department of Public Health Sciences Queen's University Kingston Canada"},{"name":"Department of Psychiatry Queen's University Kingston Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Carlone","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Queen's University Kingston Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Altomare","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Queen's University Kingston Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(18)30337-7"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajad.12823"},{"key":"e_1_2_8_5_1","unstructured":"Canada Public Health (PHA) Agency of Canada.National Report: Apparent opioid\u2010related deaths in Canada (released June 2018) [internet]. 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