Addiction and alcoholism are not new to the human experience, some people have been struggling with abuse or dependence to substances since they have existed. However, recent medical advances have brought about medications and treatments like naltrexone which have suddenly given doctors and addiction treatment professionals a potentially game-changing advantage in the fight against addiction and alcoholism.
Medication assisted treatment for substance abuse is no longer in its infancy. Drugs like methadone and Suboxone have been around for decades and both have been utilized in the fight against opiate addiction and dependence with mixed results. More recently however, naltrexone has begun to become popular as a slightly different form of medication assisted treatment which has some significant advantages over the older forms of medication assisted treatment.
Most studies which have been done to gauge the usefulness of naltrexone have shown significant promise, which has led to its increased popularity in recent years. However, most success using the drug is found when it is used in addition to, and not instead of, traditional forms of substance abuse treatment. As the field of addiction treatment moves forward it seems that medication assisted treatment is showing real promise as an additional tool to practitioners, but it is important to remember that it is not a magic bullet or a simple cure to the disease of addiction.
What is naltrexone?
Naltrexone is a medication which is used primarily to manage and treat dependence and addiction to drugs like alcohol and opiates. While it was first developed in 1965, it was not approved by the FDA until 1984 and has only recently found widespread use. This is most likely due to the explosion of opiate addiction across the country, which has created a significantly increased demand for the effective treatment of opiate dependence and addiction.
The drug is available in a few different forms such as daily tablets, extended-release injections or implants. The main difference between these forms of administration is the length that they are effective and the amount of time between doses. Tablets typically need to be taken daily, while the extended-release injections must be administered about once a month. The implants however can last anywhere between 2 and 6 months.
The length of effectiveness for a single dose of a naltrexone implant has significant advantages as it greatly reduces the danger of relapses between doses, which can occur, particularly when someone is using the oral tablet form of the drug. The main benefit the implant has over the tablet is that while the tablet is only effective if the individual decides to take it every day, the implant is effective for months at a time. Therefore, if someone decides they want to use opiates or drink alcohol the pills are very easy to discontinue while the implants are much more difficult to remove and typically require a doctor to do so.
The naltrexone implant does have some drawbacks as well, particularly due to cost. While daily tablets of the medication are rather inexpensive, the extended-release injections and the implants are often prohibitively expensive because of how new they are and the fact that the implants currently have not been approved by the FDA for their specific use as a treatment for substance abuse.
How does naltrexone work?
Naltrexone works specifically by blocking opioid receptors in the brain which affect the reward system. The drug is classified as an opioid antagonist, meaning it blocks the receptor but does not activate it like opioid agonists which activate the cell receptor sites, causing the euphoric effects which cause many people to become dependent or addicted to substances. When used properly, the antagonist effect that naltrexone has on the brain can greatly reduce, or even eliminate, the euphoric effects caused by using opiates, alcohol and potentially other substances as well.
This makes naltrexone significantly different from most other forms of medication assisted treatment for opioid abuse. Drugs like methadone and buprenorphine, which are other common medications used for the treatment of opioid abuse, are either full or partial agonists meaning that they work at least partially by activating these opioid receptor sites and can create euphoria for those that use them. This creates issues such as the potential for abuse of these drugs as well as possible withdrawal symptoms which can be associated with their long-term use.
Naltrexone on the other hand avoids most of these disadvantages. Naltrexone has not shown any significant potential for abuse because it creates no euphoric effect in the user. This also removes the risk of diversion which is a common concern for other medications like methadone and buprenorphine.
There are still some side-effects and potential disadvantages to naltrexone because of its mechanism of action however. The most significant difficulty with naltrexone treatment, particularly in opiate addicts, is the fact that its antagonist characteristics require the user to remain abstinent from all form of opiates for between 7 and 14 days. This is because the blocking effects of the drug can bring about precipitated withdrawal symptoms in those who have not completely detoxified themselves of opiates from their systems. These precipitated withdrawal symptoms can be extremely uncomfortable.
Because of this fact, beginning naltrexone treatment can be difficult for some people as they must abstain from using opiates for a week or two before they are able to begin taking naltrexone. This is just another reason why the drug is most useful when used in conjunction with other more traditional forms of substance abuse treatment like an inpatient rehabilitation program.
Other potential side effects from naltrexone:
- Stomach pain or cramping
- Loss of appetite
- Muscle or joint pain
Just like any medication, you should discuss the use of naltrexone with your doctor to decide if it is right for you and your specific situation. The drug is available by prescription only and should not be taken without the consent of a doctor as it can have serious negative side-effects for certain people, particularly those with liver issues such as hepatitis, cirrhosis or liver failure.
Naltrexone in addiction treatment
While the use of naltrexone to treat addiction is relatively new, it has shown significant promise when used correctly in conjunction with more traditional forms of substance abuse treatment. Perhaps the most helpful way to look at the drug is as a safety net to be used during the difficult and often times risky time of very early recovery. Anywhere between the first few months to a year of recovery is when a vast majority of those attempting to recover from substance abuse end up relapsing, this is the time when naltrexone can be helpful as it has the potential to reduce cravings in some individuals and also has the potential to reduce the severity of a relapse if it does occur because it may reduce the euphoric feelings users can experience if they do relapse, making an extended relapse less likely.
It is not a miracle cure however. It does not fundamentally address the actual issue which causes addiction, it simply helps to quell the neurological functions which can potentiate addiction. Because of this, naltrexone is most effective when used in conjunction with things like inpatient drug rehab, an intensive outpatient program, 12-step meetings or individual counseling sessions. In an ideal situation all of these forms of treatment would be used, but not everyone has the ability to achieve this.
No matter what an individual’s resources are however, it is crucial that they are receiving some sort of additional support to go along with their naltrexone treatment in order to make sure that they are actually addressing the emotional and mental causes of addiction. Failure to do this is actually the origin of one of the strongest criticisms of the drug. Some have come to view the drug as a way to eschew these more traditional forms of treatment, which can be costly both financially and in a sense of time and effort, and instead simply rely on the quick and easy solution of pharmaceuticals to answer their problems. This is a mistake, and while a few people may be successful this way the truth is that for a vast majority of people pharmaceuticals alone are not sufficient to adequately address the very serious and complex disease which requires similarly intensive and complex treatment.
Is naltrexone right for me?
Naltrexone can be an effective and appropriate tool in the fight against some forms of addiction and alcoholism. However, it is not appropriate for everyone nor should it be looked at as a cure or a first line of defense. Just like other forms of medication assisted treatment in the past, naltrexone has both benefits and potential drawbacks and it is important to take all of these into account when making a decision.
While there are medical studies which have shown promise for the utilization of naltrexone as a helpful way to reduce the cravings for substances, as well as the negative impact of a possible relapse, most of these studies have been based on either alcohol or opiates. Still, there are a few smaller studies which suggest it may have a positive impact on the treatment of addiction to other drugs such as methamphetamine. In any case, the current data suggests that the most appropriate candidates for the use of naltrexone as a supplement to other forms of addiction treatment are those who struggle with either opiates or alcohol.
Perhaps the most important consideration to account for is the specific history of the individual considering naltrexone treatment. The drug’s use in this specific way is relatively new and while many studies show promise, the truth is that the long-term impact of it as a form of medication assisted treatment are not completely known. Because of this it probably should not be used in those individuals who have never attempted more traditional forms of substance abuse treatment.
While there are a significant number of people who can be considered chronic-relapsers, there are many people who do find success after their first attempt at more traditional treatment methods such as at an inpatient rehab facility or at 12-step meetings. Because of this, naltrexone treatment is typically most appropriate for those who have had at least one failed attempt at traditional treatment. In those situations, then the drug can be a very useful tool, however it still needs to be used in conjunction with other more traditional forms of treatment like inpatient rehab, and intensive outpatient program or individual counseling. It is crucial to remember that it is a complement to these traditional forms of treatment and not a replacement.