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 Naltrexone cannot be administered to a patient until he or she has been totally withdrawn from opioids (a procedure known as detoxification) and has been opioid-free for at least 7 days.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 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.
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.
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.