Mental Health

Naltrexone: The Good, the Bad, and Everything in Between

America is in the midst of an addiction plague, one that leaves even the medical professionals astounded and baffled. By now, we all deeply understand the perils of our current opioid epidemic, with studies showing that more than 115 people die every day from overdoses. Read More

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America is in the midst of an addiction plague, one that leaves even the medical professionals astounded and baffled. By now, we all deeply understand the perils of our current opioid epidemic, with studies showing that more than 115 people die every day from overdoses. Moreover, alcohol-related incidents cause more than 80,000 deaths each year. Addiction is a problem affecting everyone; it’s pervasive in the homeless man down the street to the unassuming suburban housewife with a pain disorder. It’s in our schools, our jails, and our own backyards.

While recovery is possible, treatment options remain controversial and even complicated. Lately, most discussions surrounding sobriety touch upon Naltrexone- the “craving medication” commonly associated with opioid and alcohol use disorders. It’s a drug I see used in my practice on a regular basis, and it’s one that everyone should understand.

What is Naltrexone?

In a nutshell, it’s a long-lasting opioid antagonist. Endo Laboratories synthesized Naltrexone in 1963. In 1964, the FDA approved the substance for treating opioid addiction. They later approved it for treating alcoholism in 1994. Naltrexone currently exists in tablet-form, injectable form, and as a surgical implant. The medication works to reduce cravings and essentially block the desired, pleasurable effects associated with opiates and alcohol.

Unlike Suboxone or Methadone (which activate the opioid receptors), Naltrexone binds and blocks them entirely. Because of this, in theory, one cannot abuse Naltrexone (which has remained a controversial risk associated with both Suboxone and Methadone).

What are the Benefits?

Arguably, the most critical tenant associated with Naltrexone is its benefits with craving reduction. When an individual takes Naltrexone, he or she does not feel the euphoric effects of opioids and alcohol. The medication blocks that pleasure. That means, in the event of a relapse on these substances, the user does not feel the intended high- which can deter people from wanting to use altogether. In general, Naltrexone represents a medication tool assisting people to maintain abstinence.

What are the Risks?

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Like most medications, Naltrexone presents with side effects. According to the National Institute on Alcohol Abuse and Alcoholism, up to 10% of participants experience nausea, 5-7% experience depression, and anywhere between 1-5% experience symptoms of dizziness, fatigue, insomnia, and anxiety.

Medication noncompliance remains another issue- and it’s one that’s especially pertinent in those relying solely on Naltrexone for recovery. If an individual is prescribed the pill, he or she can stop taking it to get high. For this reason, it may be better individuals receive either the injectable or implanted form of Naltrexone (the implants can last up to 6 months).

Finally, if a person drinks or uses while on Naltrexone, it does not reduce the effects related to impaired judgment or inhibitions. This can be especially risky for those who may engage in risky behavior, such as driving or operating machinery, while under the influence.

Moreover, one’s dependence decreases after a period of abstinence. In this field, this the crux of the problem. People often return back to using the same amounts they once used. However, their bodies often cannot handle it, which increases the risk for overdosing and fatality.

It should also be noted that, while Naltrexone reduces and blocks opioid and alcohol cravings, it does not have the same blocking effect for other substances, such as stimulants. This is something all polysubstance users should consider: I have seen far too many clients turn to drugs like crack or meth when on Naltrexone.

Lastly, in a pragmatic sense, Naltrexone can be cost-prohibitive. While many insurance policies cover some or part of the treatment, it remains largely unaffordable for those without coverage.

The Future of Naltrexone: What’s Next?

I don’t believe Naltrexone is a cure (nothing in addiction ever is), but I do believe it can absolutely serve as an essential tool in a treatment recovery process. In my own therapy practice, I have watched many clients rebuild their lives and maintain their sobrieties- while on Naltrexone. Many of them tell me that the diminished cravings allowed them to focus on their recovery and implement the healthy coping skills needed to move forward in their lives.

We obviously need more research and evidence-based trials to justify its position within our medical community.

With that said, some studies prove to be promising. For example, in 2016, the University of Pennsylvania showed that Naltrexone actually outperformed other standard treatment modalities, such as counseling and community treatment programs in a study examining 153 ex-prisoners. Over 6 months of treatment, the Naltrexone group had a 43% risk of relapse (compared to 64% for the control group), and not one person in that group overdoses (even after accounting 18 months after the end of treatment).

Another study combining 26 clinical trials found that 19 studies showed reductions in heavy or excessive drinking, highlighting that Naltrexone can certainly have an advantage over placebo treatment methods.