Naltrexone Treatment for Opiate Overdose and Relapse Prevention


Naltrexone, an opiate treatment medication, is used to help patients make the transition from illicit opiate use to a drug-free life. Patients in naltrexone treatment are first detoxified from their dependence on opiates and then take thrice-weekly doses of naltrexone and participate in weekly group therapy sessions.

The medication provides a safety net for patients because it blocks the euphoric effects they normally would feel if they slip and use heroin or any other opiate. As a result, even relapse, which is common in addiction treatment, may have a therapeutic effect as repeated failure to get high may eventually break the neurobiological and behavioral links between taking drugs and the rewards that lead patients to resume regular drug use. With successful naltrexone treatment, slips to drug use become less frequent, the medication is discontinued, and patients continue behavioral treatment if needed.

Naltrexone treatment has been successful mainly with patients who are highly motivated to stop using opiates. Such patients include health care professionals who must stop using opiates to retain their licenses to practice medicine and individuals subject to criminal justice sanctions for relapse to illicit opiate use. The severe penalties that these patients would incur if they fail treatment enable them to overcome naltrexone's main drawback: It eliminates the powerful rewarding effects of opiates without any replacement to help patients cope with lingering effects of withdrawal.

Naltrexone's lack of a reinforcing effect has made it an unattractive treatment option for other patients who lack a strong external incentive to stop using drugs and do not want to go through detoxification and withdrawal from opiates. Most of these patients opt for treatment with medications such as LAAM and methadone, both of which help them to cope with the absence of the intense and rapid high that they are accustomed to getting from heroin by replacing it with a more moderate, stabilizing effect that can help them to maintain a nonaddicted lifestyle.

Despite its limited clinical use, naltrexone has many qualities that make it an attractive option for treating a broader range of opiate-dependent patients. It is not addicting, has few adverse effects, can be prescribed without concerns about diversion to the illicit drug market, and is not subject to the restrictive regulatory requirements that limit the use of methadone and LAAM to specialized clinics. Thus, like the recently approved opiate treatment medication buprenorphine, naltrexone can be administered in many settings, including private physicians' offices, making it more attractive to individuals who are reluctant to enter clinics.

Naltrexone's desirable therapeutic traits have continued to spark interest in finding new ways to expand its usefulness and application in practice. Two recent studies show that adjunctive behavioral and new pharmacological approaches may help to increase naltrexone's effectiveness for a wider range of opiate-addicted patients.


Robert Mathias, NIDA NOTES Staff Writer
Research Findings
Vol. 17, No. 6 (March 2003)