Naltrexone

1. Naltrexone Overview: Naltrexone is an opioid receptor antagonist. It works by binding to and blocking the effects of opioids in the brain. This means that when someone takes opioids while on naltrexone, they will not experience the euphoria or other pleasurable effects associated with opioids. Naltrexone is available in two main forms:

• Oral Naltrexone: This is taken in pill or tablet form and is usually prescribed for both opioid and alcohol use disorders.
• Extended-Release Naltrexone (Vivitrol): This is administered via an intramuscular injection once a month, and it is primarily used for OUD.

2. Use in an OTP Setting: Opioid Treatment Programs (OTPs), also known as methadone clinics, are specialized clinics that provide medication-assisted treatment (MAT) for individuals with opioid addiction. Naltrexone can be a valuable component of MAT in OTP settings in the following ways:

A. Maintenance Treatment: In OTP settings, naltrexone can be prescribed to individuals who have successfully detoxified from opioids and are no longer physically dependent on them. It serves as a maintenance treatment, helping to prevent relapse by blocking the effects of opioids. This allows individuals to focus on their recovery without the risk of getting high or experiencing cravings.

B. Transitioning from Methadone or Buprenorphine: Some patients in OTPs may wish to transition from methadone or buprenorphine (other medications used in MAT) to naltrexone. This transition should be carefully managed, and patients should be completely opioid-free before starting naltrexone to prevent precipitated withdrawal.

C. Reducing Cravings and Risk of Overdose: For patients who are at high risk of relapse or have a history of opioid overdoses, naltrexone can be a life-saving intervention. It substantially reduces the risk of opioid overdose because it prevents opioids from binding to their receptors and causing respiratory depression.

D. Alcohol Use Disorder Treatment: Naltrexone is also used in OTP settings to address alcohol use disorder. It reduces the pleasurable effects of alcohol and helps individuals control their drinking. The oral form of naltrexone is typically prescribed for this purpose.

3. Considerations and Benefits:

• Naltrexone is non-addictive, making it a suitable option for those who want to avoid opioid agonist medications like methadone or buprenorphine.
• Compliance with naltrexone treatment is easier to monitor in OTP settings, as extended-release naltrexone is administered via a monthly injection.
• Patients should be carefully screened for contraindications and must be fully detoxified before starting naltrexone to avoid precipitated withdrawal.

4. Challenges and Considerations:

• Naltrexone may not be effective for everyone. Some individuals may find it difficult to adhere to treatment due to the fear of not being able to get high from opioids.
• The cost of extended-release naltrexone injections can be a barrier for some patients, and insurance coverage can vary.
• Patients should be motivated and committed to their recovery, as naltrexone alone is not a cure for addiction. It works most effectively when combined with counseling and psychosocial support.

In conclusion, Naltrexone is a valuable medication in OTP settings, offering an option for individuals seeking recovery from opioid use disorder or alcohol use disorder. It provides an important tool to prevent relapse, manage cravings, and reduce the risk of overdose, but it should be used as part of a comprehensive treatment plan that includes counseling and support services to promote long-term recovery.

For more information, visit the SAMHSA website at the following link: What is Naltrexone?