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Presenter(s): Adam Bisaga, MD, Professor of Psychiatry, Columbia University Medical Center, New York, NY
Maintenance treatment with buprenorphine has been mainstay of office-based treatment for opioid use disorder. However, buprenorphine in not universally effective, nor is it acceptable to all patients. Approximately 50% of patients will fail to stabilize on buprenorphine, continuing to use opioids or dropping out of treatment.
The opioid receptor antagonist naltrexone acts by a different mechanism, and has the potential to attract and retain in treatment those with poor response to buprenorphine. Naltrexone is fitting for individuals seeking an opioid-free approach to recovery as it offers the promise of securing abstinence and circumventing the high relapse rates currently observed following opioid detoxification.
Naltrexone can also be used to decrease the risk of relapse following discontinuation of a successful agonist maintenance treatment, as well as in abstinent patients who are at increased risk of relapse, such as opioid abusers released from prisons or long-term residential programs.
With the available long-acting injectable formulation of naltrexone approximately 50% of patients started on naltrexone are retained in treatment and abstinent at 6 months, comparable to success rates with agonists. However, in order to safely initiate injectable naltrexone, opioid users need to be detoxified and inducted/stabilized on the medication, which involves withdrawal discomfort and the potential for treatment dropout.
This presentation, free of charge, is designed to help clinicians experienced in working with opioid abusers adopt naltrexone into their practice. Covered topics include: the rationale for using naltrexone to prevent relapse as different from agonist approach, guidelines to select most appropriate patients for treatment with naltrexone, clinical strategies to initiate treatment on outpatient and inpatient basis, safety concerns and management of side effects, and managing common clinical problems emerging during treatment with naltrexone. Clinical decision-making will be illustrated using a case report portraying a complicated treatment initiation.