What is Naltrexone?

New Approaches Seek To Expand Naltrexone Use in Heroin Treatment

Naltrexone is a medication that is used in the treatment of opiate addiction and alcoholism. Recovering heroin addicts who take the medication cannot get high, even if they try to take heroin again; as a result, they are much less likely to use heroin.

Naltrexone for opiate addiction is sold in the United State under the brand name ReVia. Although the medication works by affecting opiate receptors in the brain, the drug is not addictive.

What Does Naltrexone Do?

Naltrexone is a type of drug that is known as an "opiate antagonist." This means that it travels to the brain and attaches to opiate receptors, but does not activate them. If these receptors are filled with heroin or other opiates, naltrexone will bump the other drugs out of the way and block all the receptors, thereby neutralizing the effects of the other opiates.

If you take naltrexone and heroin at the same time, you will not get high.

Naltrexone Can Cause Precipitated Withdrawal

No one with a physical dependency to opiates can use naltrexone until they are completely free from opiates and opiate withdrawal symptoms. Ridding the body of opiates usually takes seven to 10 days after the last consumption, but depending on the drug the waiting time can be longer.

Naltrexone has a very strong affinity for the opiate receptors, and can easily push out any opiates that are currently occupying and activating these receptors. If an opiate-dependent person takes naltrexone, all opiate receptors become inactivated, and the net effect is an immediate crash into withdrawal.

How is Naltrexone Taken?

Opiate addicts who are in recovery take naltrexone as a daily pill. Naltrexone can also be injected.

A newer delivery system for the medication is the naltrexone implant, which is a small pellet of naltrexone that is surgically implanted into the wall of the abdomen and which slowly releases naltrexone into the body over a period of months. The Naltrexone implantation has not yet earned approval from the U.S. Food and Drug Administration (FDA) for the treatment of opiate addiction, although it is sometimes used in private clinics.

You cannot take naltrexone concurrently with other opiates, and as such, it cannot be used with either methadone or buprenorphine (Suboxone or Subutex).

Risks and Side Effects of Naltrexone

Naltrexone is a fairly well tolerated medication, and most people report no side effects. The most commonly reported side effects of naltrexone (from a study of the medication on alcoholics) include the following:

  • Nausea (10 percent of cases)
  • Headache (seven percent of cases)
  • Depression (between five and seven percent of cases)

Naltrexone can be toxic to the liver, and patients will commonly have liver tests done prior to treatment (to form a baseline and to ensure suitability for the medication) and frequently during the course of treatment.

The use of naltrexone in opiate addiction treatment may put people at an increased risk of opiate overdose. People who use heroin after skipping a dose of naltrexone will have no opiate tolerance, and what was previously a "normal" amount of heroin for them during the pre-naltrexone treatment period can be enough to kill them.

Problems with Naltrexone Treatment

  • Oral naltrexone treatment generally relies on patient compliance, and so it works best for people who are intrinsically motivated to stay clean. Naltrexone treatment patients have to take their pills every day for the treatment to work, and they can use again as soon as they stop taking the medication. Additionally, naltrexone won't help with drug cravings – naltrexone treatment patients still have to deal with this precursor to relapse.
  • Naltrexone implants circumvent the problem of patient compliance, but are not yet approved by the FDA for the treatment of opiate addiction.
  • Naltrexone does not seem to be as effective as either methadone or buprenorphine in keeping people from relapsing back into opiate use

Naltrexone can help a motivated recovering opiate addict avoid relapse, but for better odds of success, naltrexone patients must also participate in continuing addiction treatments, such as behavioral therapies and support groups.

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