Naltrexone is intended to help people who have an opioid or alcohol addiction. Users take it to decrease alcohol and opioid cravings. It also is used to block the euphoric and sedative effects of opioids whether they are of the prescription medication or illicit drug variety.
Naltrexone has gained popularity over the years as health officials and lawmakers look for effective solutions to answer the damage wrought by the ongoing opioid epidemic, which seems to get worse by the year. The drug crisis claims an estimated 130 lives a day in the U.S. Of the estimated 72,000 drug overdose deaths that occurred in 2017, opioids caused about 68 percent or 49,000 of them.
For the first time in U.S. history, a person is more likely to die from an accidental opioid overdose than a motor vehicle crash, announced the National Safety Council in 2019.
However, users have experienced varying degrees of success with opioid treatment medications like naltrexone, buprenorphine, and Suboxone. However, they are increasingly being employed in medication-assisted treatment (MAT) programs to address alcohol, heroin, morphine, and codeine addictions.
Despite its approval by the Food and Drug Administration (FDA), naltrexone can produce its share of adverse and uncomfortable side effects. Plus, there are questions about its true efficacy.
Read on to find out more about how naltrexone works, its side effects, and the controversy surrounding it.
Naltrexone was first synthesized in 1963 by researchers at a small New York-based pharmaceutical company. Two years later, it was discovered to be an orally active and long-acting opioid antagonist.
The medication was patented in 1967 and later acquired by DuPont in 1969. It wasn’t until 1984 that the FDA approved the oral medication to treat opioid dependence under the brand name Trexan. It would also be approved to treat alcohol dependence in 1995 under the brand name ReVia. An injection form of naltrexone was approved for alcohol and opioid dependency in 2006 and 2010, respectively. This form of naltrexone is marketed under the brand name Vivitrol.
Naltrexone comes as a tablet, which is either taken at home or under supervision at a treatment center. Whether taken at a treatment center or clinic, naltrexone should be taken either once a day, once every other day, once every third day, or once every day with the exception of Sunday.
The injection form of the medication is administered into the muscle of the buttocks once every four weeks by the designated health care provider.
Naltrexone is supposed to be used only when someone has completed detoxification, meaning that the addictive substance must be removed from the person’s body and that the person must be medically stabilized before beginning treatment.
As an opioid antagonist, naltrexone works by binding to the opioid receptors in the brain. This action blocks the receptor and prevents a user from feeling the euphoric and sedative effects of the opioids. How it works to treat alcohol dependence is not fully understood. However, it blocks a user’s ability to feel the euphoria associated with detoxification.
This also compels users to reduce their drinking enough to stay in treatment and avoid relapse.
Additionally, naltrexone has been deployed in a practice known as the Sinclair Method, which uses an opiate blocker to turn a “habit-forming behavior into a habit-erasing behavior.” The intended outcome of this practice is that it places someone’s alcohol craving back to the level it was before they became addicted. What’s more, proponents argue that the Sinclair Method has a 78 percent long-term success rate.
Users are directed to take this medication while they are receiving professional treatment for their addiction. When patients take naltrexone along with attending counseling sessions, support group meetings, various therapies, and educational classes, studies have indicated that it has helped them to avoid using drugs and alcohol.
If someone relapses and resorts to using the addictive drug, naltrexone will prevent that user from getting high.
Also, the extended-release, injectable version of naltrexone (Vivitrol) has been shown to relieve cravings, dispel fears of withdrawal, effectively block opioid use and its intended effects, according to a report published by Dr. Arthur Robin Williams in the Psychiatric Times. Users have also reported that naltrexone is incapable of being abused.
Some significant cons are associated with naltrexone. First, it decreases a user’s tolerance to opioids, which means that if someone relapses and goes back to using the same amount of opioids before treatment, they have a heightened risk of experiencing overdose and death.
Second, it is more expensive than other opioid treatment drugs like Suboxone. The cost of a single dose can be as high as $1,000.
While Suboxone and other partial opioid agonist medications only require a partial detox period before use (usually between 12 hours to two days), naltrexone requires full detoxification to prevent a user from experiencing acute opioid withdrawal. This detox period can take up to 10 days, depending on the seriousness of the abuse.
What’s more, naltrexone produces its share of side effects, mainly those of the gastrointestinal variety. Side effects associated with naltrexone include:
Serious side effects from naltrexone include blurred visions, hallucinations, severe vomiting and/or diarrhea, and confusion. What’s more, naltrexone may cause liver injury, injection site reactions, and allergic pneumonia.
Alkermes, the Dublin-based makers of Vivitrol, have been the subject of controversy surrounding marketing efforts and claims about the drug. For instance, Vivitrol was approved by the FDA based on one study where nearly half of all the participants who used the medication failed to stay abstinent over a six-month period.
Executives with the drug maker were accused of levying unfounded criticisms against rival medications. For instance, company executives discredited mainstay opioid treatment drugs in pitches to various parties, including investors, doctors, law enforcement officials, and legislators.
Meanwhile, Alkermes was able to realize unprecedented revenue off of Vivitrol, thanks to an innovative marketing campaign that targeted lawmakers, judges, and prisons.
According to a March 2018 report, Vivitrol’s promotion led to “sales in 2017 totaling $269.3 million, which is up from $144.4 million in 2015.” This represents a nearly 87 percent jump. What’s more, Alkermes “projected sales of $300 million to $330 million in 2018, with that figure jumping to $1 billion by 2021.”
Once again, naltrexone should only be used by people who have completed detox. It should not be used by people who have drug or alcohol withdrawal symptoms or for those who have taken an opioid medicine within the past two weeks, according to Drugs.com.
Medication-assisted treatment, or MAT, is a type of addiction treatment that uses medications such as naltrexone, buprenorphine, or methadone, along with counseling and behavioral therapies, to treat substance abuse.
Therein lies the benefit of MAT in a professional treatment setting: the ability to access a range of services proven to effectively treat alcohol and opioid addictions.
People who are addicted to opioids or alcohol can cease using their substance of choice by using these medications. A licensed physician administers or prescribes these medications. Typically, patients will take their daily dose in that physician’s office.
Unlike the original medical detox model, where users are given medication for a few days, MAT may require patients to stay on these medications for a few months or even a few years.
Though patients are supposed to undergo MAT along with a combination of counseling and therapy, critics view this practice as a crutch. Instead of addicted persons seeking out long-term recovery through abstinence, they may be perceived as relying on MAT drugs as a replacement for their substance of choice.
In addition to naltrexone, other MAT drugs include:
In professional treatment, not only will you be able to take medications to assist in your opioid or alcohol addiction, but you will also be exposed to a range of evidence-based treatment approaches to help you maintain your sobriety and reclaim your life.
The types of therapies you can utilize in treatment include the following:
Cognitive behavioral therapy (CBT): With cognitive behavioral therapy (CBT), you will receive treatment that addresses the negative thoughts and actions associated with addiction. At this stage, you will learn practical strategies and skills to combat old habits
Dialectical behavioral therapy (DBT): With dialectical behavioral, you will learn about the triggers that lead to substance abuse.
Motivational interviewing: In motivational interviewing, you will not only identify key issues, but you will also learn how to think positively and embrace changes that can improve your life.
Educational classes: These classes are used to inform patients about drug-related subjects, including addiction, relapse, withdrawals, abuse, overdose, and many other things are covered in treatment educational classes.
About: The Sinclair Method. (n.d.). from https://cthreefoundation.org/the-sinclair-method
Durkin, E. (2018, August 16). US drug overdose deaths rose to record 72,000 last year, data reveals. from https://www.theguardian.com/us-news/2018/aug/16/us-drug-overdose-deaths-opioids-fentanyl-cdc
Goodnough, A., & Zernike, K. (2017, June 11). Seizing on Opioid Crisis, a Drug Maker Lobbies Hard for Its Product. from https://www.nytimes.com/2017/06/11/health/vivitrol-drug-opioid-addiction.html
Lynne.walsh. (2015, June 16). Naltrexone. from https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone
Naltrexone Uses, Side Effects & Warnings. (n.d.). from https://www.drugs.com/mtm/naltrexone.html
Naltrexone: MedlinePlus Drug Information. (n.d.). from https://medlineplus.gov/druginfo/meds/a685041.html