What is safe to take with naltrexone, and what is not safe to take with naltrexone?
Naltrexone is an opioid antagonist drug, which means that it blocks opioid receptors. It is used to treat opioid use disorder and alcohol addiction. Naltrexone therapy for opioid addiction and naltrexone therapy for alcohol addiction, in addition to psychotherapy and social support, can be very effective treatment strategies.
Additionally, naltrexone is used at very low dosages in a treatment known as low dose naltrexone (LDN). LDN is used to treat a variety of conditions, including some chronic pain issues, such as fibromyalgia and complex regional pain syndrome. Naltrexone used for these conditions at low dosages is relatively safe, and reported as being effective for many patients for pain relief and improved functioning.
Because of naltrexone’s activity as an opioid receptor antagonist, or opioid receptor blocker, it is important to avoid consuming opioid drugs, or opioid-like drugs before, or during naltrexone treatment. There are serious adverse effects that may occur, when naltrexone is taken by a person who is also taking an opioid drug, whether it is heroin, fentanyl, or other opioid street drugs, or a prescribed opioid pain medication.
When we think of opioids, we may first think of pain meds, such as oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine, codeine, and others. And, of course, in addition to opioid pain medicine, there are street opioids, including the dangerous fentanyl analogs which have now infiltrated nearly every type of street drug.
Opioids, opiates, and opioid-like drugs and substances should be avoided before and during naltrexone therapy.
In addition to these commonly known opioids, there are also drugs that act like opioids, but they are not considered to be opioids. For example, there is tianeptine, an atypical antidepressant.
Tianeptine, sold as the brands Stablon and Coaxil in European countries, is not approved by the FDA. While not an opioid, tianeptine acts like an opioid at the opioid receptors.
People in the United States have obtained access to tianeptine by ordering it online from countries where it is legal. By taking large amounts, they are able to get an opioid-like high.
While not an opioid by definition, a person who takes naltrexone while having tianeptine in their system, may go into acute opioid withdrawal, or precipitated withdrawal. Tianeptine should be discontinued at least a week before starting naltrexone treatment.
Another opioid-like drug that is commonly used in the United States is Kratom. Kratom is a plant-based substance that is sold in special kratom bars or cafés. It is also sold in gas station convenience stores and from online sellers.
While kratom proponents will argue that kratom is not an opioid, it will react with naltrexone in the same way as an opioid. As my podcast guest, David Poses, stated in our interview, “If it walks like a duck and quacks like a duck…”
Kratom users who start naltrexone while kratom is still fresh in their system will also experience the adverse effect known as precipitated opioid withdrawal. They will have a sudden onset of opioid withdrawal symptoms.
Is it safe to eat cheese while taking naltrexone?
Is cheese really an opioid? I didn’t think it could be possible, especially because I love cheese, and we keep it in the house without any concern for locking it up or watching how much is being consumed by the family.
Yet, I saw a post by a kratom advocate in which she stated that if we are going to call kratom an opioid, we might as well call cheese an opioid also. I looked it up, and she was right. Cheese does, apparently, have opioid-like properties.
While I agree that cheese does seem to be somewhat addictive, especially when melted on a delicious pizza, it seems almost funny to even consider putting this dairy staple into the same category as heroin and fentanyl. Yet, it does bring up some interesting questions regarding naltrexone treatment.
Sometimes, when a patient begins taking naltrexone for alcoholism or opioid addiction, they feel sick from the medication. The usual advice is to start at a lower dosage and give the body time to get used to the new medication.
Usually this works, taking naltrexone 25 mg for several days before increasing to 50 mg daily or as needed for alcohol reduction therapy. But, is it possible that people who feel sick with common side effects from naltrexone are having a dietary interaction? Could it be cheese-induced withdrawal syndrome?
Since we know that kratom and tianeptine, two non-opioid drugs that interact with the opioid receptors, can cause precipitated opioid withdrawal syndrome, when the user takes naltrexone, could cheese do the same thing? What about other foods that might act like mild opioids?
As we learn more about how various foods affect the brain, we may have to consider making dietary recommendations to patients who are about to start taking naltrexone. While there are likely no studies on this topic, it is interesting to consider dietary habits when starting on a course of naltrexone therapy. Doctors may want to ask the patient about their diet and, at least, recommend holding off on cheese intake for a while.
Why is naltrexone not used more often as medication assisted treatment to treat opioid dependence and addiction to opioid medicine and street opiates?
The issue of precipitated withdrawal makes starting naltrexone fairly difficult for patients with a drug addiction that involves opiates. Oral naltrexone tablets quickly interact with any opioid medication or opioid drug in the patient’s system.
The typical medical advice for someone considering naltrexone use for treating opioid substance abuse is to wait at least one week after the last opioid use before starting naltrexone. The problem is that naltrexone will displace any residual opioids in the system, causing a precipitated withdrawal reaction.
Because of this precipitated withdrawal, naltrexone as an addiction resource in opioid addiction treatment is of limited usefulness. It is an excellent treatment to be started during an extended stay in rehab, but it is difficult to start in outpatient clinics.
Is it possible that microdosing naltrexone might be a solution? This works with buprenorphine, another addiction treatment drug for opioid use disorder.
Buprenorphine is a powerful opioid receptor blocker, just like naltrexone. The main difference is that buprenorphine is also a partial agonist, which is why it is categorized as an opioid, even though it is also a blocker, unlike any other opioid.
When a patient takes buprenorphine, the main ingredient in Suboxone, too soon, it also causes precipitated withdrawal symptoms. One solution is something called the Bernese Method, which is a microdosing solution, taking small doses of buprenorphine and gradually increasing the dose on a daily basis. This is also known as microinduction.
Naltrexone is already prepared by compounding pharmacies in low dose form, so it would not be hard for a patient to obtain a prescription of low dose naltrexone for the purpose of microdosing and gradually increasing naltrexone to avoid precipitated withdrawal.
Getting through the withdrawal period before starting naltrexone is very difficult for people addicted to and dependent on opioids. The peak of withdrawal symptoms typically occurs around 72 hours after the last opioid use.
However, once a patient has started naltrexone therapy for opioid addiction, it has a fairly high success rate. In fact, the success rate of naltrexone MAT is approximately the same as that of buprenorphine. While naltrexone relapse does occur, the opioid blocker is more effective than nonmedical therapies alone.
Should alcohol be avoided when taking naltrexone?
Naltrexone is approved by the FDA for treating both opioid use disorder and alcohol use disorder. While opioid addicted patients must not consume opioids during naltrexone treatment, the same is not necessarily true for alcohol addicted people.
Originally, when doctors began prescribing naltrexone for alcohol detox treatment, they instructed their patients to stop all alcohol consumption before taking the medication. Treatment often starts with an uncomfortable detox period, where the patient would quit drinking and then experience alcohol withdrawal symptoms.
Alcohol withdrawal is both unpleasant and dangerous. Medical supervision is required to help the alcohol abuse patient get through the acute alcohol withdrawal phase safely.
However, there is another way to use naltrexone to treat alcohol dependence without the traumatic response of going cold turkey and then treating the acute alcohol withdrawal syndrome. Pharmacological extinction, also known as The Sinclair Method, is another way to use naltrexone that involves taking the medication while still drinking alcohol.
So, while many doctors may not be aware of the fact that naltrexone can be taken safely with alcohol, facilities and doctors who use The Sinclair Method to treat their patients understand that this harm reduction method of tapering off of alcohol is both safe and effective.
Are there other illicit drugs, besides heroin, fentanyl, and other opioids that must not be taken with naltrexone?
As we have discussed, when a person has been recently taking opioids takes naltrexone, they experience precipitated withdrawal, which is a highly unpleasant reaction caused by the opioid blocker interacting with the opioid drug remaining in the person’s system. What about other drugs bought on the streets, such as cocaine, amphetamine, marijuana, or Xanax bars?
If a drug user could be certain that the drug they were purchasing had no opioid or opioid-like substance in it, they would not have any issue taking naltrexone. In fact, naltrexone has been demonstrated in studies to be useful in treating stimulant addiction.
Naltrexone does not have a drug interaction with cocaine, meth, or other amphetamine drugs. It does not interact with weed or alprazolam. Yet, there are circumstances where any of those drugs may cause a patient taking naltrexone to go into precipitated withdrawal.
Unfortunately, fentanyl analogs have infiltrated every drug that is sold on the streets. Fentanyl has been found in cocaine, causing cocaine users to experience a life-threatening opioid overdose.
The deadly synthetic opioid has also been found in cannabis and even fake pressed Xanax pills. Drug users must be aware that fentanyl may be present in any drug obtained on the streets.
Because of this omnipresence of fentanyl, it is possible for a person who believes that they have not consumed an opioid to have large amounts of the synthetic opioid in their system. If a person takes fentanyl after, for example, taking a fake Xanax pill, they will go into precipitated withdrawal.
While precipitated withdrawal is not a life-threatening reaction in most cases, it is so unpleasant that it can discourage an opioid user, or other drug user, from seeking help with their addiction again for a long time. When doctor-prescribed naltrexone makes a patient severely ill, they may feel betrayed, and they will not take the chance again any time soon of getting that sick again.
Should people who take naltrexone avoid having fun?
Why do the human body and brain even have opioid receptors? The purpose of these receptors can not possibly be so people can take opioid drugs for pain management or to get high. Of course, opioid receptors do serve a purpose not related to the consumption of exogenous opioids, such as heroin, fentanyl, or pain pills.
As you may already be aware, the endogenous opioid system of the human central nervous system does serve a purpose in an ancient region of the brain, the reward system. The reward system is actually made up of multiple brain regions, and it uses endogenous opioids, or endorphins, to provide a sense of pleasure as a reward when the person performs an act that promotes the survival of the individual, or of the species.
For example, eating food, exercising, and sex are activities that provide positive feedback via endorphin release. The reward center imprints the memory of pleasure associated with the activity, so the person knows which activities should be repeated in the future.
Do modern humans require this reward center in their brains to help guide them in their survival? We might argue that modern society and technology have led to a complex world, where our brain’s reward system is not necessary, and may even be harmful.
There are some people who believe that medications that block opioid receptors interfere with the necessary functioning of the human central nervous system and the ability to enjoy basic life activities. They are concerned about not being able to enjoy simple pleasures, such as eating fine foods, exercising, playing, or having intimate time with their partner.
The fact is that the brain has the ability to adjust to changes, such as ongoing blockade of the opioid receptors by an opioid receptor blocking medication, such as naltrexone, or buprenorphine. The human central nervous system is robust and can function just fine in the modern world, even with the activity of the ancient reward system of the brain partially blocked.
As it turns out, people who take potent opioid blockers on a regular basis, such as naltrexone, or buprenorphine, for long periods are able to engage in recreational activities and enjoy them very much. Our brains are too rich and complex to allow the partial blocking of an ancient opioid reward system to slow us down.
People who take naltrexone should have fun, by engaging in safe activities. They should learn to be aware of the moment and have an appreciation for the fulfillment provided by enjoying life activities with family and friends.
Is naltrexone a safe medication?
Asking about the safety of a prescription medication is important. Even if your doctor assures you that a drug is safe, you may want to consider doing additional research, using reputable sources to review side effects and drug interactions.
Naltrexone does interact with receptors in the brain, and there are other prescription medications that block or activate brain receptors that may cause long-term problems. The medical community is only beginning to understand the risks associated with drugs, such as antidepressants and antianxiety meds, and other psych drugs.
So far, it appears that naltrexone is a relatively safe drug for most people, and by protecting patients from alcohol or opioid relapses, it often provides a benefit far greater than any risk of harm.
Additionally, low dose naltrexone (LDN), which is used for a variety of treatments for pain syndromes and more, is used at such a low dosage, far below the usual therapeutic dose, that it may also be considered relatively safe.
There has even been a movement to recommend making naltrexone and other over-the-counter drugs. One day, we may see naltrexone on the shelves of grocery stores, right alongside ibuprofen and aspirin.
As we have discussed here, there are certainly things to be avoided before and during naltrexone therapy. If you have any questions about what to avoid taking while on naltrexone, I recommend informing your doctor about your concerns and asking, “is it safe to take naltrexone?”