Naltrexone is a medication that is used to treat both alcohol dependence and opioid dependence.
Naltrexone is a prescription medication that is classified as an opioid antagonist. That means that it blocks opioid receptors. With studies demonstrating the effectiveness of naltrexone treatment, the drug has been approved to treat alcohol addiction and opioid addiction.
When a doctor prescribes a new medication to you, your first question might be to ask about side effects of naltrexone. All medications have side effects. You are going to want to know what to expect.
You may have heard that naltrexone can cause abdominal pain, including abdominal cramping and diarrhea. While most patients will not have an issue with gastrointestinal side effects, they are possible, due to the effects of naltrexone on intestinal opioid receptors.
One way to minimize or avoid altogether the common naltrexone side effects is by starting out with a lower dosage in the beginning. The treatment dosage for most patients is 50 mg daily. Your doctor may recommend starting at 25 mg daily for several days, to help your body get used to the medication.
Another common concern regarding oral naltrexone and naltrexone injections and implants is the possibility of liver damage. Does naltrexone cause liver damage?
Well, naltrexone is not likely to cause problems with the liver at normal therapeutic dosages. The idea of naltrexone-related liver damage may be due to an early study where patients were given very high levels, as high as 300mg daily.
Still, your doctor will most likely order a liver function test before starting treatment or enquire about recent testing you may have had done. Also, you may have additional testing done during and after treatment.
Can naltrexone put me into full opioid withdrawal?
Have you ever seen someone in opioid withdrawal or experienced it yourself? It is one of the most unpleasant experiences.
Unfortunately, people who do not understand the physical response of a person quitting opioids abruptly may view the withdrawal response with contempt. They point their righteous finger and declare the suffering victim of opioid withdrawal to be a junkie and an addict.
I have seen people have their pain medication taken away by hospital doctors, and then when they go into withdrawal, the doctor admits them to a psych ward. This has happened during a routine hospital admission for an unrelated problem.
It is critical that we understand that opioid withdrawal is a completely physical response, separate from addiction. It has no bearing whatsoever on a person’s moral status. There is no need to lecture someone while they are suffering from a physical response to medication or drug withdrawal.
In fact, addiction itself is a medical condition and not at all a moral failing. It is true that a person may be compelled by active addiction to commit crimes, and they will have to take responsibility for their actions, but addiction is a mental health condition with proven and effective medical treatments in many cases.
Hopefully, we are coming out of the dark ages of treating addiction as a moral issue that should only be treated by spiritual practices and not with evidence-based medical therapies. Before practicing tough love by kicking a family member out onto the streets and calling them an addict, consider the possibility that taking them to a doctor or hospital for treatment is a more reasonable approach.
Naltrexone should not be taken during or immediately after opioid use.
To answer the previous question, naltrexone can certainly cause precipitated withdrawal symptoms in a person who is currently taking opioids. It does not matter if they are taking prescribed opioids for chronic pain or street opioids to get high, such as heroin or fentanyl.
If you take opioids and you are interested in taking naltrexone, you must be opioid-free for one to two weeks first. Naltrexone treatment must be administered by a doctor who is familiar with the drug’s interaction with opioids and opioid-like medications and drugs.
If you are in a long-term residential rehab facility for opioid addiction, you will be in an excellent position to take naltrexone by the end of your stay. The rehab doctor will be able to give you naltrexone while still under observation and long after your last opioid use.
Rehabs often prefer to give naltrexone in the long-acting shot form. The naltrexone injection is known by the brand name, Vivitrol.
Is naltrexone an opioid? Can I take naltrexone if I am in recovery in Narcotics Anonymous or Alcoholics Anonymous?
This is an excellent question. There are medications that are classified as opioids that are used for addiction treatment.
There is buprenorphine, the main ingredient in the prescription medication, Suboxone. And, there is methadone, a powerful opioid used by methadone maintenance clinics to keep people off of deadly street opioids, such as heroin and fentanyl.
While buprenorphine is very different from other opioids, being both an opioid receptor blocker, and only a partial agonist, or activator, it is still considered to be an opioid. Suboxone is interesting, in that people tend not to abuse it to get high and it is not addicting in the way many other opioids can be.
Even though people who are prescribed Suboxone are able to function normally in their lives, working at jobs and taking care of their families, there is significant stigma associated with opioid addiction treatment with Suboxone. This is unfortunate, because when family, friends, coworkers, and even complete strangers try to convince you to stop taking your Suboxone too soon, the results can be tragic.
Interestingly, Narcotics Anonymous, an international addiction recovery organization, has an official position against medications used to treat addiction. This is reminiscent of certain religions forbidding life-saving treatments, such as vaccines and blood transfusions, because they have interpreted their scriptures and found that modern medicine breaks their moral code.
Yet, while the “high priests” of Narcotics Anonymous gather at area service meetings and world service meetings to evaluate the appropriateness of medical treatment for addiction, people are dying from opioid and alcohol overdoses and conditions related to the use of these drugs. NA leaders have used the process of “group conscience,” a blend of democratic voting and prayer, to decide the fates of many of their struggling members.
What do the leaders of NA think about naltrexone?
NA is a large organization with meetings in nearly every city and town on earth. It is second only to Alcoholics Anonymous in size and influence. Even the courts compel people who go before a judge for addiction-related crimes to attend these meetings. In an NA meeting, a person on Suboxone or Naltrexone may find themselves indoctrinated with the message that addiction should only be treated with abstinence.
As they say in the Spiderman movies and comics, with great power comes great responsibility. These large and powerful addiction recovery fellowship organizations are overstepping when they publish edicts of how addiction should be treated. The healthcare industry has strict standards of who may engage in medical decision making for individuals suffering from health-related conditions.
Hospitals are already finding themselves being held accountable for preaching the abstinence message to people who pass through their emergency departments after near-death experiences with alcohol or opioid overdoses. While NA and AA are more on the side of being organized religions than healthcare institutions, they may find that they have to be more careful in how they spread their message and what effects they have on people who would benefit from medical treatment.
Unfortunately, while naltrexone is not at all an opioid, it is often confused with medications such as buprenorphine and Suboxone. Naltrexone is an opioid blocker. It blocks opioid receptors without activating them at all. It is what is known as an antagonist and it is not at all an agonist.
Patients have been turned away by doctors after asking for a naltrexone prescription. Many doctors believe that because naltrexone interacts with opioid receptors, it must be some sort of opioid. They think people are getting high with naltrexone and they don’t want anyone trying to pull the wool over their eyes.
Recovery groups, such as NA, may group naltrexone in with Suboxone and methadone as well, simply stating that when someone blocks their opioid receptors with a doctor-prescribed medication, their ability to live a happy, joyous, and free life in recovery is diminished. Therefore, they do not get to count clean time in their home group.
Sometimes, the thinking of recovery leaders can be confusing.
I have heard, many times, people in recovery recommend to a newcomer to not take doctor-prescribed medications for addiction. Occasionally, I have heard of leaders in recovery recommending an herbal product named Kratom. Kratom is a plant that acts as if it is a mild opioid and it is a street drug. Kratom proponents will fight to the end to insist that it is technically not an opioid and how it can help people to recover from opioid addiction.
In my experience, this currently legal street drug has led to deadly opioid overdoses by stimulating cravings in its users. While some people may have found it to be beneficial, it is not a chance worth taking.
The reason for even bringing up the kratom vs prescription medication issue is to point out that in the recovery world, there is a general distrust of doctors and medical treatment. Even rehabs often like to call their customers “clients” rather than “patients” to distance themselves from the medical establishment.
The medical director of a rehab is often held back at arms length, only being able to perform a basic general physical upon admission for new clients, while the rehab provides minimally trained staff to lead group therapy sessions on a daily basis for the duration of the rehab stay.
We might say that stigma is also a side effect of naltrexone.
Is it possible for social reactions to people taking prescribed medication to be considered a side effect? And, why spend so much time discussing stigma as a side effect when there are actual documented side effects that affect some patients early in treatment, such as headaches, dizziness, and upset stomach?
The issue is that those actual medical side effects are usually not a major problem. Naltrexone is a relatively safe drug, on par with many over-the-counter (OTC) drugs.
In fact, there is already a movement to push for naltrexone to be approved as an over-the-counter medication. Naloxone (Narcan), a closely related live-saving opioid receptor blocker, is already on a fast-track for FDA approval to be OTC.
Yet, stigma as a side effect is probably the worst of all side effects and most likely to lead to a patient stopping treatment too soon. It is an unusual reaction to taking a prescribed medical treatment that leads to friends and family shaking their heads in disapproval.
When it comes to the typical medical side effects of naltrexone, the best way to deal with them is to start at a lower dosage and gradually increase to the therapeutic dosage. This reduces the chance of having an upset stomach or headache from naltrexone.
What is the best way to avoid the stigma of evidence-based, proven medical therapy with naltrexone, a drug that is not habit-forming, mind or mood-altering, or abusable in any way?
How do we keep patients from dealing with situations where a family member, friend, or even well-meaning gas station attendant tries to convince them to stop their medication? The two best ways to prevent this social side effect of addiction treatment is to use discretion and to provide education. First, when receiving medical treatment for any medical condition, be careful about whom you share your private and protected health information with.
You have a right to privacy. Most people have no reason to know that you see a doctor or take medication. While it may be tempting to proudly discuss your successful medical treatment, keep in mind that the response you get from many people will not be what you expect.
Our society is very primitive when it comes to accepting advances in medical treatments for addiction. Unfortunately, we are stuck back in the dark ages, where “spiritual practices” such as taking moral inventories to list character defects and personal shortcomings are considered superior to modern medicine.
Education is the key to long-term success.
As impossible as it sometimes seems, we must continue to press forward with educating the public, especially thought leaders and political leaders, on the benefits of medical treatment for addiction. It is important that people see that medication-assisted treatment of various substance use disorders can be safe and effective.
Scientists are often not fans of hyperbole and self-promotion. Medical articles are written in formats following strict convention and are given humble titles and introductions. The medical field could use some public cheerleaders to promote the benefits of modern medicine without getting too caught up in listing rare and disturbing side effects of treatments.
While it is important to be thorough and rigorous in presenting scientifically proven medical treatments, it is also important to give perspective by being clear about the great benefits of effective medical treatment.
Naltrexone is a drug. It is an FDA-approved medical treatment with indications for treating opioid addiction and alcohol addiction. Like any real medical treatment, as opposed to snake-oil remedies, naltrexone does have real side effects that can affect some individuals who take it.
However, the side effects of naltrexone are often mild and are not too common. Over the counter medications are also drugs with side effects. Yet they are considered to be safe enough to give the public the freedom to read the label and make their own decisions.
Over the years, medications that were once thought to be dangerous, only to be prescribed by board-certified specialists, have been found to be safe enough to trickle down to the general practitioners, and finally to OTC status.
Omeprazole, or Prilosec, is an example of such a drug. This stomach acid fighting medication was once considered to be a treatment that only gastroenterologists should be prescribing. After a few years on the market, the word got out that it was safe enough for any doctor to prescribe. Now, anyone can walk into their local supermarket and find it on the shelf near the Pepto Bismol and Maalox.
Naltrexone is a similarly safe drug that was once prescribed only by specialists. Because of the strange stigma against medical treatment of addiction, naltrexone may sublimate through the process, straight from a rarely prescribed drug right to being available to the public, over the counter.
Doctors are also caught up in the issue of stigma as a side effect, refusing to prescribe this relatively safe and very effective medication because of their own prejudices about addiction and addiction treatment. Naltrexone has been around for a long time and it has stood the test of time.
In addition to being used to treat opioid and alcohol addiction, naltrexone is used for other treatments as well. Low dose naltrexone, which is naltrexone at dosages usually under 5 mg, is prescribed for various auto-immune conditions and pain syndromes. As you can imagine, low dose naltrexone side effects are far less likely than naltrexone prescribed at the usual therapeutic levels.
For now, you still must go to a doctor to get a prescription for naltrexone. It is, after all, a real medical treatment that does have possible side effects. Someday, you will likely be able to make the choice of taking naltrexone on your own, without having to ask for the approval of your doctor.
If you are living in the Fort Lauderdale area, or anywhere in Florida, and you are interested in Naltrexone treatment and you have questions about side effects, please send a message through this website. We would be happy to help you to find answers to your questions.