Low-Dose Naltrexone
Sahar Swidan, Matthew Bennett in Advanced Therapeutics in Pain Medicine, 2020
Naltrexone is an opiate antagonist approved by the Food and Drug Administration for use in alcohol and opiate agonist dependence. Naltrexone, at normal doses of 50 mg to 150 mg daily, has traditionally been used for the treatment of alcohol and opiate agonist addiction. A Cochrane review investigating the effects of naltrexone therapy on alcohol dependence found that it reduced the risk of heavy drinking by 83% and decreased drinking days by 4% compared to placebo. Additionally, using fillers such as calcium carbonate during compounding can reduce absorption of naltrexone, thereby affecting the pharmacokinetic profile, and should be avoided. Instead, inactive fillers such as Avicel®, sucrose, or lactose should be used in compounding. These immune, inflammatory, and opioid effects are key in managing the pathophysiology and progression of diseases such as multiple sclerosis, Crohn’s disease, sarcoidosis, fibromyalgia, complex regional pain syndrome, painful diabetic neuropathy, autism, infections, and cancer.
Harm Reduction Models
Cyndi Turner in The Clinician’s Guide to Alcohol Moderation, 2020
Edith Springer is attributed with bringing harm reduction to the United States. A social worker in a methadone clinic in New York, she traveled to Great Britain during the 1980s and observed how differently they were treating their patients. Harm Reduction Psychotherapy is a drastic shift from traditional treatment models and programs. The majority of treatment programs require abstinence from all mood-altering substances to enter the program. Alcohol moderation is a form of harm reduction. It challenges the way people have been creating public policy and providing treatment in the United States. The Sinclair Method was developed by the late Dr. David Sinclair. It involves taking Naltrexone one hour prior to drinking alcohol to create “pharmacological extinction.” Motivational Interviewing is a counseling theory that was developed by William R. Miller and Stephen Rollnick.
Pharmacotherapies for PTSD and Substance Use Disorders
Anka A. Vujanovic, Sudie E. Back in Posttraumatic Stress and Substance Use Disorders, 2019
This chapter provides an overview of the pharmacotherapies for comorbid posttraumatic stress disorder (PTSD)/substance use disorder (SUD). It summarizes clinical and epidemiological studies examining the co-occurrence of PTSD/SUD, followed by an overview of some of the biological mechanisms common to these disorders. The chapter reviews pharmacological treatments for clients with PTSD, SUD, and PTSD/SUD and discusses promising new targets for medication development. It describes the available evidence for the pharmacological treatment of the specific substances. Several pharmacotherapies have been used effectively in the treatment of alcohol use disorders (AUD). A meta-analysis examined the effectiveness of Food and Drug Administration-approved and off-label medications for adults with AUD. Research on the use of pharmacotherapy for the treatment of other SUD is less developed compared to AUD and opioid use disorder (OUD). Treatments for OUD include buprenorphine, methadone, and naltrexone. Newer evidence with intramuscular naltrexone suggests that this formulation may be more effective than oral.
Rapid transition from methadone to buprenorphine using naltrexone-induced withdrawal: A case report
Published in Substance Abuse, 2019
Heather Burrell Ward, Brian S. Barnett, Joji Suzuki
Background: Patients taking methadone for opioid use disorder may desire transition to buprenorphine for a number of reasons. However, the current recommended approach for this transition generally takes weeks to months as an outpatient, causing considerable discomfort to the patient and a heightened risk of relapse during the transition period. Case: We describe the case of a patient on methadone maintenance who was rapidly transitioned to buprenorphine because of her desire to not return to her methadone clinic. In order to rapidly transition the patient from methadone to buprenorphine, naltrexone was administered to precipitate acute opioid withdrawal, which was followed soon after by buprenorphine induction. Discussion: Rapid transition from methadone maintenance to buprenorphine can be accomplished in inpatients by precipitating acute withdrawal with naltrexone, providing an effective alternative for patients who cannot tolerate the typical protracted methadone taper required prior to buprenorphine induction as an outpatient.
Favorable Mortality Profile of Naltrexone Implants for Opiate Addiction
Published in Journal of Addictive Diseases, 2010
Several reports express concern at the mortality associated with the use of oral naltrexone for opiate dependency. Registry controlled follow-up of patients treated with naltrexone implant and buprenorphine was performed. In the study, 255 naltrexone implant patients were followed for a mean (± standard deviation) of 5.22 ± 1.87 years and 2,518 buprenorphine patients were followed for a mean (± standard deviation) of 3.19 ± 1.61 years, accruing 1,332.22 and 8,030.02 patient-years of follow-up, respectively. The crude mortality rates were 3.00 and 5.35 per 1,000 patient-years, respectively, and the age standardized mortality rate ratio for naltrexone compared to buprenorphine was 0.676 (95% confidence interval = 0.014 to 1.338). Most sex, treatment group, and age comparisons significantly favored the naltrexone implant group. Mortality rates were shown to be comparable to, and intermediate between, published mortality rates of an age-standardized methadone treated cohort and the Australian population. These data suggest that the mortality rate from naltrexone implant is comparable to that of buprenorphine, methadone, and the Australian population.
The Impact of Depressive Symptoms on the Efficacy of Naltrexone in Smoking Cessation
Published in Journal of Addictive Diseases, 2008
Zach Walsh, Alyssa Epstein, Geetha Munisamy, Andrea King
In the current double-blind study, we examined the impact of depressive symptoms on the efficacy of naltrexone as an adjunct to smoking cessation treatment. Participants were 110 adult nicotine dependent smokers interested in quitting smoking. All subjects received behavioral counseling and nicotine patches. Subjects were randomly assigned to the naltrexone or placebo group. Naltrexone was administered daily starting three days prior to the quit date (25 mg daily) and continued for 8 weeks thereafter (50 mg daily). Smoking cessation status was assessed at the end of treatment and at 24 week follow-up. The efficacy of naltrexone was moderated by depressive symptoms such that naltrexone was related to better quit rates than placebo at higher levels of depressive symptoms. These findings suggest that individual differences in depressive symptoms may be important determinants of clinical response to naltrexone, and may help to clarify discrepancies in prior studies of naltrexone and smoking cessation.
Related Knowledge Centers
- Naloxone
- Opioid Antagonist
- Methadone
- Fda
- Heroin ADDiction
- Overdose
- Sinclair Method