Naltrexone is an opioid antagonist medication that works by blocking the effects of opioids. Patients taking naltrexone receive a monthly injection, which reduces cravings for heroin/opioids and also blocks the brain’s opioid receptors from the patient feeling any euphoric effects should they impulsively use heroin. Naltrexone cannot be administered to a patient until he or she has been totally withdrawn from opioids (a procedure known as detoxification) and has been opioid-free for at least 7 days. Naltrexone prevents relapse and can also be used by patients who have been in treatment and have tapered off buprenorphine as an added protection against relapse.
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The third module highlights various aspects of maintenance treatment with naltrexone such as side-effects and safety concerns including ongoing opioid use and the risk of overdose. Clinical challenges seen during treatment with naltrexone and strategies to manage them are discussed as well as the management of relapse, treatment of pain, and mood effects. Finally, the module examines the logistics of using an injectable form of naltrexone.
The second module focuses on the selection of potential candidate patients for naltrexone and procedures to initiate treatment with naltrexone. The module reviews several treatment initiation scenarios that clinicians might face. Detailed protocols to treat opioid withdrawal are offered, each matching patient’s physiological conditions, to assure that patients can be successfully and safely inducted onto naltrexone. Behavioral strategies to increase patient’s engagement in treatment during the induction process are also discussed.
This introductory module is a case-based discussion of the general approach to evaluation and treatment of patients presenting with problematic opioid use. Benefits and limitations of available medications and differences between them are described. An approach to choosing first and second line treatments is also presented.
Naltrexone, an opioid receptor antagonist, is one of only three medications approved by the FDA to treat opioid use disorder (OUD). Use of naltrexone is presently limited to specialized addiction treatment settings, in part because of the few training opportunities for medical providers on the use of naltrexone. This module presents a summary of a 4-modules training program on the use of naltrexone developed by PCSS.
The first module presents background information on the use of opioid antagonists in treatment of OUD. It describes the clinical pharmacology of naltrexone and its mechanism of therapeutic effect, the differences between agonist and antagonist based treatment, the development of various preparations of naltrexone and highlights the available evidence for its efficacy.
Naltrexone offers an approach to abstinence that differs from other current therapies and it attempts to discourage the use of some of the most commonly abused substances currently in the U.S.- mainly narcotics and alcohol. But, one of the biggest barriers to physicians utilizing it more widely is fear of its hindrance on the treatment of pain and a lack of understanding and knowledge on the subject. The presentation will consist of 25 slides on the subject of Naltrexone and its impact on the treatment of pain. The slides will include background information, epidemiology, treatment options and recommendations on the topic, as well as some clinical experiences with this problem.
MAT in the OTP Setting: Integrating the Three Approved Medications (Methadone, Buprenorphine, ER Naltrexone)Kelly J. Clark, MD, MBA | Chair, OTP Workgroup, American Society of Addiction Medicine
This module will give the clinician an understanding of the opportunities and challenges of integrating into the Opioid Treatment Program (OTP) environment treatment with all three FDA approved medications – methadone, buprenorphine (SL and buccal), and ER Naltrexone. The special characteristics of OTPs, and its place in the continuum of care, provide a unique environment for these pharmacotherapies. This module will discuss these, as well as clinical and operational issues involved in developing an integrated approach.