"These guidelines were produced by the World Health Organization (WHO), Department of Mental Health and Substance Abuse, in collaboration with the United Nations Office on Drugs and Crime (UNODC) a Guidelines Development Group of technical experts, and in consultation with the International Narcotics Control Board (INCB) secretariat and other WHO departments. WHO also wishes to acknowledge the financial contribution of UNODC and the Joint United Nations Programme on HIV/AIDS (UNAIDS) to this project. " - p. iv

Introduction: Opioid use disorder (OUD) is highly prevalent among incarcerated populations, and the risk of fatal overdose following release from prison is substantial. Despite efficacy, few correctional facilities provide evidence-based addiction treatment. Extended-release injectable naltrexone (XR-NTX) administered prior to release from incarceration may improve health and economic outcomes.Methods: We conducted an economic evaluation alongside a randomized controlled trial of testing the effectiveness of XR-NTX before release from prison (n=74) vs. XR-NTX referral after release (n=72) of participants with OUD who were incarcerated, both groups continuing treatment at a community addiction treatment center. The incremental cost-effectiveness ratio was used to assess cost-effectiveness of the XR-NTX before release compared to referral after release for three stakeholder perspectives at 12- and 24-week periods: state policymaker, healthcare sector, and societal. Effectiveness measures included quality-adjusted life-years (QALYs) and abstinent years from opioids. Resources were categorized as OUD-related and non-OUD related medical care, state transfers payments, and other societal costs (productivity, criminal justice resources, etc.).Results: XR-NTX was associated with greater OUD-related costs and total costs from the state policymaker perspective. QALYs gained were positive but statistically insignificant between arms; however, XR-NTX was associated with an estimated 15.5 more days of opioid abstinence over 24 weeks and statistically significant at a 95% confidence level. Estimated ICERs were found to be > $500,000 per QALY for all stakeholder perspectives. For the abstinent-year effectiveness measure, XR-NTX before release was found to be cost-effective at a 95% confidence level for willingness-to-pay values >$49,000 per abstinent-year, across all perspectives. Conclusions: XR-NTX administered to persons who are incarcerated with OUD before release may provide value for stakeholders and bridge a well-known treatment gap for this vulnerable population. Lower than expected participant engagement and missing data limit our results.

Alcohol use disorder (AUD) is a major public health problem in the United States. The estimated 12-month and lifetime prevalence values for AUD are 13.9% and 29.1%, respectively, with approximately half of individuals with lifetime AUD having a severe disorder. AUD and its sequelae also account for significant excess mortality and cost the United States more than $200 billion annually. Despite its high prevalence and numerous negative consequences, AUD remains undertreated. In fact, fewer than 1 in 10 individuals in the United States with a 12-month diagnosis of AUD receive any treatment. Nevertheless, effective and evidence-based interventions are available, and treatment is associated with reductions in the risk of relapse and AUD-associated mortality. The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder seeks to reduce these substantial psychosocial and public health consequences of AUD for millions of affected individuals. The guideline focuses specifically on evidence-based pharmacological treatments for AUD in outpatient settings and includes additional information on assessment and treatment planning, which are an integral part of using pharmacotherapy to treat AUD. In addition to reviewing the available evidence on the use of AUD pharmacotherapy, the guideline offers clear, concise, and actionable recommendation statements, each of which is given a rating that reflects the level of confidence that potential benefits of an intervention outweigh potential harms. The guideline provides guidance on implementing these recommendations into clinical practice, with the goal of improving quality of care and treatment outcomes of AUD.