Substance use disorder (SUD) and alcohol use disorder (AUD) remain serious problems in the United States and across the globe. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 20.3 million people aged 12 or older have experienced substance use disorder, and an estimated 14.5 million people ages 12 and older suffer from AUD. These disorders are serious health conditions that affect people from all walks of life.
According to the American Psychiatric Association (APA), substance use disorder is a complex condition characterized by uncontrollable use of substances despite harmful consequences.
To overcome addiction and maintain prolonged recovery, an integrated treatment plan is needed that involves a medically assisted treatment program, therapy, counseling, a support group, and an aftercare program. The medical aspect of treatment provides individuals with specific medications that help them taper off of substance use. One such drug that has been manufactured and marketed for this purpose is Naltrexone.
Naltrexone is an effective tool in the management of alcohol use disorder and opioid use disorder (OUD). Naltrexone strengthens the treatment process to a great extent by helping people safely and gradually stop using alcohol or opioids.
Naltrexone is a prescription medication sold under the brand names ReVia and Vivitrol. This medication was approved by the US Food and Drug Administration (FDA) to treat opioid dependence and alcohol dependence, the two highest forms of substance use disorders present in the US. It is estimated that around 130 people die each day due to opioid-related drug overdoses, and an average of 6 people die of alcohol poisoning each day in the US.
It is available in a pill form (ReVia) for alcohol use disorder or as an extended-release intramuscular injectable (Vivitrol) for both conditions. The injectable form of naltrexone can only be prescribed and administered by licensed practitioners.
To avoid detox withdrawals, people who take naltrexone must refrain from taking drugs or alcohol for at least 7-10 days before beginning treatment. This includes those who previously used methadone and are in the process of transitioning to naltrexone.
Addiction (substance use disorder) is a lifelong illness that requires lifelong treatment. Similar to other chronic diseases such as diabetes or hypertension, addiction also requires medication and ongoing care to maintain recovery.
Addiction is also referred to as a relapsing disease. Addiction relapse rates are similar to those of chronic illnesses such as hypertension and asthma, which also have physiological and behavioral components. Treatment of chronic diseases as such involves changing deeply embedded behaviors through behavioral therapies and counseling.
Since there is no one size fits all solution to addiction treatment, relapse does not indicate failure but instead the need for adjustments in the treatment program to better suit individual needs.
So how does naltrexone treat addiction? Naltrexone works in three ways. It helps block the effects of the opiates, decrease cravings for alcohol or opiates, and interfere with the desire to continue drinking in case of a relapse.
Naltrexone can help with substance use disorder by tremendously decreasing chances of a relapse and improving focus on additional elements of recovery.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), medication for addiction treatment (MAT) is the use of medications approved by the Food and Drug Administration (FDA) in combination with counseling and behavioral therapies. MAT provides a “whole-person” approach to addiction treatment. It is an evidence-based treatment program that is clinically driven and tailored to meet each person’s individual needs.
Research indicates that this combination of medication and therapy can successfully treat alcohol use disorder and opioid use disorder and help sustain recovery. Naltrexone is utilized in MAT programs to address cravings of alcohol and opioids and to help prevent the risk of an opioid overdose.
The pill form of naltrexone is taken daily, and the extended-release injectable is administered once a month by a licensed practitioner. Naltrexone is not recommended for anyone younger than 18 years of age or individuals experiencing certain medical health conditions.
Naltrexone is a non-addictive medication that doesn’t cause withdrawal symptoms during cessation. The medication starts to take effect within 30 minutes after its use. And the dosage can vary from one person to another. Missing doses of naltrexone can decrease its effectiveness and increase your chance of a relapse.
Naltrexone functions by:
Among the many benefits of using naltrexone, the main benefit is that it doesn’t have the potential for abuse, addiction, or dependence. However, naltrexone isn’t a cure for addiction, nor does it cure dependency. It simply helps maintain sobriety while focusing on the other aspects of treatment.
Naltrexone can interact with other medications and cause dangerous side effects. Since the drug is used to treat alcohol and opioid use disorder, other substances must be avoided at all costs to prevent any sudden withdrawal symptoms. Before using naltrexone, inform your physician of any other medications you’re currently on, including over-the-counter drugs and herbal remedies to avoid complications. The following medications can adversely interact with naltrexone:
Naltrexone is not the same medication as Narcan, also named Naloxone. Although these two medications might look and sound similar, they are however fundamentally different.
The action of naltrexone does not undo the effects of opioids; it prevents the euphoric sensation they cause. On the other hand, Narcan alters the adverse effects of potent opioids. According to the National Institute on Drug Abuse (NIDA), Narcan is a medication designed to reverse an opioid overdose quickly. It is an opioid antagonist that binds itself to opioid receptors and reverses and blocks the effects of other opioids.
When someone is experiencing an opioid overdose, they must seek immediate medical attention. Many emergency healthcare providers have Narcan on hand to counteract a possibly fatal overdose.
It is theoretically possible to overdose on naltrexone, if someone were to take a massive dosage of opioids or consume a lot of alcohol in an attempt to counteract the effects of naltrexone, this can lead to an overdose.
A missed naltrexone dose should be taken as soon as possible. But if it’s close to the next dose, it is best to avoid the missed dose. However, take the next dose at the usual time. Do not double the dosage to catch up on the missed dose as it may lead to an overdose.
All medications come with their own set of side effects, some more serious than others. If you experience any during naltrexone treatment, do not stop using it before consulting your doctor first.
If you experience too many side effects of naltrexone, your doctor can decrease the dosage or substitute naltrexone with another medication to treat opioid or alcohol dependence. However, most side effects of naltrexone will decrease over time. The most common side effects of naltrexone include:
Naltrexone can cause serious side effects in rare circumstances, including liver damage and injection site reactions. In some cases, naltrexone can trigger allergic reactions (allergic pneumonia). If you encounter any of these side effects, contact your physician immediately.
Medical experts recommend that you talk to your doctor before starting naltrexone treatment about the following situations to lower your chances of side effects:
Considering your medical conditions, your doctor can determine the safest dose of naltrexone.
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