Naltrexone Treatment & Support Program for Alcohol & Opioids

Naltrexone (brand names Vivitrol, Revia, Depade) is a medication used to help those addicted to alcohol or opioid drugs manage their dependence and prevent relapse. The FDA approved naltrexone for use in three different routes: in pill form, in an implant device, and, in the case of Vivitrol, as an extended-release intramuscular injection administered once a month by a qualified medical provider.

Naltrexone is specifically designed to be used in conjunction with a comprehensive drug and alcohol addiction recovery program and should only be administered by a healthcare professional.

The main reason naltrexone is so effective is its ability to deliver a highly effective medication for alcoholism and opioid addiction uninterrupted for one full month.

Patients taking naltrexone orally (by mouth) need to remember to take it every day for it to be effective. As with any patient who has a chronic illness and has to take medications daily, it is possible to simply forget or stop taking the medication for a variety of reasons.

Another reason people stop taking oral naltrexone every day has to do with how effective the medication can be. Patients often take it for a few weeks or months and feel as though they are in control of their drinking or drug use. This can lead them to stop taking the medication.

Unfortunately, oral naltrexone’s positive “anti-alcohol” effects wear off after about three days, which is when the cravings return, making them vulnerable to relapse.

The breakthrough at the heart of Vivitrol’s success is that, in addition to delivering the same benefits as oral naltrexone, it also remedies the critical issue of compliance because it continues to work even during a “weak” moment.

Naltrexone is what’s known as a non-addictive opioid antagonist. Naltrexone makes it easier for patients to stop abusing alcohol and opioids by blocking certain receptors in the brain that, when stimulated by these substances, give users a “high” or “rush” by releasing feel-good chemicals like dopamine into their system.

In simpler terms, if someone taking naltrexone drinks alcohol or uses an opioid, they can’t get drunk or high.

This makes alcohol and opioids less alluring and prevents relapse by causing several things to occur:

• Naltrexone decreases cravings for alcohol and opioid drugs by up to 90%.
• If a patient drinks alcohol while on naltrexone, it blocks the euphoria they would normally get from drinking*.
• Because naltrexone binds with opioid receptors, it prevents opiates like heroin from taking effect at all. Therefore, when the patient is on naltrexone, they can’t get high.

*Note that drinking on naltrexone will still produce symptoms of intoxication, like slurred words or poor balance, but patients don’t benefit from any of the positive (pleasant) effects of alcohol.

Unlike other treatments such as disulfiram (Antabuse) that deter people from continuing to drink by making them sick if they consume alcohol, naltrexone discourages people from wanting to drink or use opioids in the first place.

By preventing patients from getting drunk or high, naltrexone is a powerful tool for preventing relapse and helping patients stay committed to their treatment so they can learn the appropriate coping skills to allow them to live in their normal environments and deal with stress in healthy ways rather than using alcohol or drugs as their primary coping mechanism.

The duration of a dose of naltrexone depends largely on the method of administration. Naltrexone is typically given either orally or as a once-a-month extended-release injection.

The average duration of effects with oral administration varies depending on the dosage, but typically ranges from 24 to 72 hours. Because the Vivitrol injection is a different, time-release formulation, the medication will last for about 4 weeks.

Most patients begin to feel the effects of the medication within the first 2-3 days of starting their first injection. Subsequent Vivitrol injections are then administered each month for the medication to continue working.

This depends largely on the individual. Factors such as how long the patient was using alcohol or opioids, whether there are any co-occurring mental issues or cross-addiction risks, as well as other factors, need to be considered before discontinuing naltrexone treatment.

The good news is that naltrexone can be safe and effective when used either short- or long-term. Most patients benefit most from at least one year of Vivitrol injections.

Naltrexone has several potential side effects. These can range from mild to more severe, depending on the individual and the dosage form (oral tablets or extended-release injectable). Here’s a breakdown:

Common Side Effects:

1. Nausea
2. Headache
3. Dizziness
4. Fatigue or tiredness
5. Insomnia
6. Anxiety or nervousness
7. Joint or muscle pain
8. Loss of appetite

Less Common but Potentially Serious Side Effects:

1. Liver Damage
   • Elevated liver enzymes or signs of liver toxicity (e.g., jaundice, dark urine, abdominal pain).
   • Risk increases with high doses or preexisting liver conditions.
2. Injection Site Reactions (for Injectable Naltrexone)
   • Pain, swelling, or hardening of the skin at the injection site.
   • Rarely, more severe reactions like tissue damage.
3. Depression or Mood Changes
   • Rarely, it may exacerbate depressive symptoms or cause mood swings.
4. Allergic Reactions
   • Rash, itching, or swelling. Severe reactions, such as difficulty breathing, are rare.
5. Opioid Withdrawal Symptoms (if taken too soon after opioid use)
   • Includes sweating, vomiting, diarrhea, muscle cramps, and anxiety.

Precautions and Considerations:

• Avoid Opioids: Naltrexone blocks opioid receptors, and using opioids while on naltrexone can cause withdrawal symptoms or make the opioids ineffective.
• Alcohol Use: It’s crucial to discuss alcohol use while on naltrexone with a healthcare provider.
• Pregnancy and Breastfeeding: Limited studies are available, so it’s important to consult a doctor before using naltrexone during pregnancy or breastfeeding.

Naltrexone is generally safe when prescribed and monitored by a healthcare provider. It’s approved for the treatment of alcohol and opioid dependence, helping reduce cravings and prevent relapse. Unlike some other treatment options, naltrexone is non-addictive and does not produce a “high.” However, it must be used cautiously, especially in individuals with liver issues or those who have recently used opioids, as taking it too soon can cause withdrawal symptoms. Regular medical check-ins and lab tests can help ensure its safety.

One of the reasons naltrexone has few side effects is its intramuscular injection delivery method. By being injected into the muscle where it can slowly release into the bloodstream, the medication initially avoids going through the liver before it goes into the rest of the body.

One of the liver’s main functions is to break down different substances, including medications. When any medication is able to bypass the liver initially, less of it is destroyed, leaving more of it is available. Thus, a patient needs a much lower dose to be effective (in the case of naltrexone injection, 70% less).

This overall lower dose of naltrexone produces minimal side effects compared to oral administration. As an added bonus, because of the way Vivitrol gets into the bloodstream, it also provides four times the brain levels of the oral dose, so more medication is available to help the brain.

As with any medication, it’s important to discuss any concerns with your doctor and determine if it’s right for you.

Another critical success factor for the use of naltrexone for alcohol and opiate addiction is that the patient’s family and overall support system can significantly benefit from their loved one’s usage of the drug, particularly with the extended-release Vivitrol injections.

Once someone gets the injection, their family knows that for the next 30 days, they won’t be able to experience any intoxication from alcohol or opioid use. Additionally, cravings will decrease by 90%, in general, which helps with mood and irritability issues that can accompany stopping these substances.

In the extensive research and clinical use of naltrexone for alcohol and opioid treatment, physicians have found that once a family understands the significant benefits, they begin to feel some “control” returning to very chaotic, “out-of-control” home environments.

Vivitrol is the first anti-addiction medication for alcoholism and opiate addiction that provides this sense of control for the family members, as the patient cannot change the effects of the medication once the injection is received.

Family members and others in the patient’s support system quickly realize that if they help the alcoholic or opiate addict to just get to treatment every 30 days, Vivitrol can make a tremendous difference in all of their lives.