Who is a good candidate for XR -naltrexone?
Patients who are already fully detoxified from opioids (in particular those in inpatient, residential, or criminal justice settings) can easily start XR-naltrexone without fear of precipitating withdrawal. The FDA-indication for XR-naltrexone is to prevent relapse to opioid use. However motivated patients with a strong preference for XR-naltrexone can undergo withdrawal management so that they are fully detoxified in order to be inducted on their first injection as well. Ideally patients would have access to all three classes of medications and be able to make an informed choice with the guidance of their care team.
Does it matter if I prescribe oral naltrexone or use the injectable XR-naltrexone?
Yes! Patients often discontinue oral naltrexone and this poses an increased risk of overdose death. This relative increased risk is not observed with the injectable XR-naltrexone which lasts for a month and then slowly leaves patients’ bodies. Even if patients ask for a pill, they should be encouraged to receive the injection instead.
