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Dispelling Myths About Naltrexone: Is It Right for You?

Dispelling-Myths-About-Naltrexone-Is-It-Right-for-YouNaltrexone has been around for decades as a treatment for those struggling with opioid or alcohol dependence, first in pill form and now as a once-a-month injection marketed under the name Vivitrol.

Despite its long-term presence on the scene, confusion about naltrexone’s efficacy and appropriateness abound. Here’s a look at a few myths surrounding this increasingly popular addiction medication to help you determine if it might be right for you:

Myth 1: It’s not that effective.

Historically, it has been hard to judge how well naltrexone worked because patients needed to take it every day. If they missed even a few doses, its benefit was lost. It is now clear that when the pills are taken as directed or the intramuscular injections are received monthly, naltrexone offers significant relief for many who struggle with addictions to alcohol or opioids.

The medication works by blocking opioid receptors in the brain. This translates into different effects for different substances. In terms of opioids – heroin or OxyContin, for example – naltrexone blocks the “high.” Thus, the reward mechanism that spurs use is eliminated. That means less possibility of relapse and a chance to concentrate on recovery. For some, naltrexone can also reduce cravings.

With alcohol, the effect is different and not as well-understood, but it is believed that the blocked opioid receptors minimize the euphoria associated with drinking. The less euphoria, the less a person is likely to drink. This effect is most pronounced in those with a specific gene variant, a 2011 study found.

While naltrexone may not prompt complete abstinence from alcohol on its own, multiple clinical trials show that it can significantly reduce relapse rates, the number of drinking days, the amount of alcohol consumed, as well as help break the drinking cycle. It can also reduce cravings.

Naltrexone isn’t meant to be used alone but rather as part of a comprehensive treatment program designed to teach strategies for remaining substance-free.

Myth 2: It’s too hard to stick with the program.

When naltrexone was first introduced back in the 1980s, it was available only in pill form. It quickly became evident that many find it hard to commit to taking the pills consistently, especially when they know that by skipping doses, they’ll be able to feel a high from opioids or alcohol within a couple of days.

Those who break from the program and return to opioid use in this way face a big danger: overdose. That’s because those who use naltrexone must first have opioids out of their system. Tolerance is lost. If use picks up where it left off, the overdose risk skyrockets.

The arrival of the extended-release form of naltrexone, Vivitrol – approved in 2006 to treat alcohol dependence and in 2010 for opioid dependence – eliminated these concerns for those who fear they may have trouble with compliance. The once-a-month shot takes away the need for the day-to-day decision-making that comes with pills. Compliance gets easier and after an injection the risk from overdose is nearly eliminated for an entire month.

An even newer formulation, an extended-release naltrexone implant, has been used successfully in other countries for several years, but it has not yet been approved for use in the U.S.

Myth 3: It’s just one more drug to abuse.

Treating drug addiction with drugs may seem like a bad idea to some. But addiction is a chronic, relapsing disease that requires multifaceted treatment, and evidence-based medications – when used as part of a program of counseling, therapy and support – can help users regain the control they need to work on getting their lives back.

Unlike some other medications for drug and alcohol abuse, naltrexone is not addicting and cannot be used to get high. It can be stopped at any time without prompting withdrawal symptoms and without inducing cravings. It also can be administered by any medical physician and can be taken for as long as needed. It does not require an individual to go to a special clinic to be treated.

Myth 4: It’s too expensive.

Vivitrol, the extended-release injectable, is recognized as the most effective form of naltrexone – and it doesn’t come cheap at about $1,000 per injection. That single dose, however, provides protection for an entire month and, more importantly, helps users stick with treatment.

It’s an investment that can pay off. A recent study published in the Journal of Substance Abuse Treatment determined that using Vivitrol can actually lead to lower healthcare costs overall, in part because it can decrease the time spent in treatment facilities. An earlier study came to the same conclusion, noting that total healthcare costs were 30 percent lower for patients who received medication for their alcohol dependence,and injectable naltrexone had the edge.

If the cost remains out of reach and insurance doesn’t help cover it, a lower cost, generic form of naltrexone is available in pill form.

Myth 5: It has too many side effects.

Like any medication, naltrexone is not completely risk-free, but the most common side effects are relatively minor – issues such as upset stomach, diarrhea, headache, sleep problems and joint pain, and these can usually be eliminated through an adjustment in dosage.

In rare cases, liver problems have been reported, but these have been linked to excessive dosages. To be on the safe side, liver function tests are usually carried out before treatment begins and periodically throughout. Other serious but uncommon side effects include allergic reactions; get help immediately if you notice a rash, facial swelling, or have chest pain or trouble breathing.

It’s also wise to carry a medical card stating that you are taking naltrexone so that any emergency responders will know that you cannot feel the effects of opioids and will need special care if in pain.

Probably the biggest danger comes from those who decide to try to break through naltrexone’s block on their high by taking large amounts of opioids. Attempting to do so can lead to overdose and death.

Finding Help

If you are interested in naltrexone, talk to your doctor to find out if it’s a good choice for you. Naltrexone can be provided by a physician or through an addiction treatment facility. If you need help finding a doctor who dispenses the once-a-month naltrexone shots, check out Vivitrol’s Find a Doctor tool.

Dispelling Myths About Naltrexone: Is It Right for You?


David Sack, M.D.

Dr. David Sack is board certified in psychiatry, addiction psychiatry, and addiction medicine. As CMO of Elements Behavioral Health, he oversees a nationwide network of treatment centers including drug and alcohol rehab programs at The Ranch in Tennessee and The Right Step in Texas.


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APA Reference
Sack, D. (2015). Dispelling Myths About Naltrexone: Is It Right for You?. Psych Central. Retrieved on July 21, 2019, from https://blogs.psychcentral.com/addiction-recovery/2014/11/dispelling-myths-about-naltrexone-is-it-right-for-you/

 

Last updated: 9 Jun 2015
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