Does naltrexone work?

Dear Stanton:

I understand that you don’t subscribe to the disease theory of addiction (understatement of the year!). However, do you believe that some therapies may allow patients to exert greater control over their substance abuse problems? I am thinking particularly of Naltrexone/Revia which may allow patients to drink without kindling major relapse.

This would seem to be a potentially useful adjunct in the transition from uncontrolled to controlled drinking. I would be interested in your thoughts on this. While AA claims no official position on Revia or ‘any other drug,’ it’s clear they don’t like the implications of the widespread use of drugs like this because it will ultimately begin to erode their influence.

I am a physician and a member of the American Society of Addiction Medicine. However I find the 12 step approach facile. Frankly I think there is as much science in a 12 step meeting as there is in a meeting of Elks or Goodfellows (the latter making no claims and providing an infinitely better time).

Sincerely,
Peter […], MD

P.S. Superb Website!


Peter:

Thanks for the kind words. By the way, what is the scuttlebutt around ASAM concerning the judgment and million dollar award against G. Douglas Talbott — the founder and past president of ASAM — and his colleagues for false imprisonment, fraud, and malpractice for the misdiagnosis and forced treatment of a Florida doctor (and also that former ASAM president Anne Geller testified on behalf of the plaintiffs against Talbott et al.)?

Naltrexone is a long-acting opioid antagonist that blocks opioid receptors, supposedly reducing craving while diminishing tolerance for both opioids and alcohol. Why this drug should also act to block alcoholic craving when alcohol does not have target receptor sites always puzzles me. This suggests that naltrexone is acting through general experiential effects rather than through its specific action as an antagonist. You know, for centuries, therapies have been built on alternate drug experiences that block or replace opiate and other cravings (heroin was introduced as a chemical substitute for morphine, alcohol, and cocaine; barbiturates were likewise marketed for their anticraving effects; and so on).

Obviously, a drug that reduced the likelihood of alcoholic relapse, even after drinking, has a place in treatment. But, I strongly suspect early enthusiasm about naltrexone in alcoholism treatment will quickly fade.

This has already occurred in heroin addiction treatment, and especially in the country (Australia) where its use was most quickly and widely embraced (for use by general medical practitioners). Of course, naltrexone has been used for decades in heroin treatment. There was widespread enthusiasm for its generic use in Australia, and GPs were given prescribing privileges for it. There has now been considerable retrenchment. James Bell, in Australia, indicated, “We have enough research in Australia to say Naltrexone is of limited value [for opiate addicts]. Overseas evidence suggests only about 10 percent do well on it.” Of course, any improvement with Naltrexone has to be matched with the improvement shown by untreated addicts.

Bell’s evaluation of the actual (as opposed to experimental) use of Naltrexone in the Medical Journal of Australia was scathingly negative: not only did Naltrexone fail to end addiction for virtually all addicts, it increased the risk of overdose. Of 30 addicts prescribed naltrexone, by three months only six were still taking it, four of whom still sometimes used heroin.

Right now, Naltrexone is being pushed by Charles O’Brien and Joseph Volpicelli, at the University of Pennsylvania, as well as government agencies. In experimental programs, Naltrexone has been reported to reduce drinking days and quantities. But we must be aware that these findings — just like those in Project MATCH — occur under highly artificial clinical trials. When the drug is spread to the general population of clinicians and alcoholics, I predict its apparent efficacy will disappear.

Remember, Peter, you heard it here first.

Best wishes,
Stanton


Stanton:

Thanks for getting back to me so quickly. I am not quite so saturnine about the prospects of Naltrexone. Certainly a universal problem with this drug is patient compliance. I was unaware of the Talbott case but you have certainly piqued my curiosity. I assure you it hasn’t been headline news in the ASAM newsletter!! I believe that this discipline suffers under the weight of a tyrannical orthodoxy. Is any other area of medicine so at the mercy of a cult? Thank you for having the courage to challenge this juggernaut.

Best wishes,
Peter


Hi my name is Alison and I have drinking excessively for about 2 years and I want to stop but I just can’t how, I take Naltrexone every morning but it doesn’t help lot and I have a kid who is begging me to stop he is 15 and cries almost every time he sees me drink, how can I stop this? or some ways to help me stop would be great, please help me.

Sincerely Alison

Stanton Peele

Dr. Stanton Peele, recognized as one of the world's leading addiction experts, developed the Life Process Program after decades of research, writing, and treatment about and for people with addictions. Dr. Peele is the author of 14 books. His work has been published in leading professional journals and popular publications around the globe.

Comments

  • Kathleen McLane says:

    I have been dealing with overuse of alcohol for 30 years. I have followed the AA principles for many of these years, with mixed result. Recently, I viewed the documentary, The Little Pill and met with my doctor to discuss using Naltrexone and the Sinclair Method. After a month of taking Naltrexone in pill form once per day, and following the Sinclair Method, I have noticed fantastic results. Not only do I no longer want to drink to excess, but I’ve noticed a big drop in my alcoholic thinking. Things that formerly triggered thoughts of alcohol are no longer causing me to obsess. I am very happy to feel ambivalent about drinking for the first time in 30 years. I have a few friends who like me, did not click with the AA thinking. I have recommended Naltrexone in conjunction with a doctor and counseling. I feel free from my alcoholic thinking and triggers. It has changed my life significantly and I intend to continue with the treatment. I have had no side effects yet, however, was advised to get a blood test for liver function after a few months.

  • Undesired Thoughts says:

    I have problems with unwanted sexual thoughts and they have caused horrible results in my life and other’s lives. I take Naltrexone now, and while it hasn’t cured me, it has helped me cope better and my life is more productive than before.

  • Billy says:

    So many people are kidding themselves. The only advice I can give alcoholics is the same thing that worked for me. If you are drinking a dozen beer a day you have to force yourself, or have someone close who is with you 24/7 to force you to only drink half that or even less. Whatever you can drink the absolute minimum amount of and not have withdrawal effects is what will eventually help you quit for good. After a couple weeks of this or even 1 week cut it down some more and continue this process until you dont need the alcohol to curb withdrawal effects. This helped me 100% cure my alcohol addiction…once at 18 and then again at 22, so I guess it wasn’t 100% the first time as I managed to think I could drink without becoming an addict again…this also happened due to going back to hanging with the people who not only allowed the behaviour but supplied the alcohol). I’ve been alcohol free for 8 years (with the exception of maybe 4-6 beer once every 8-10 months… but this is a BAD idea for anyone whose love of excessive alcohol hasn’t almost completely died like mine has. I also beat a 2 year cocaine addiction the same way, it started to become a daily thing about 2 years after the alcohol stopped.. but in just a 2 week period of weaning off of it I was done for good. In 6 years I’ve done maybe 10 lines of coke and none of them were in the last 3 years. Sadly my addictions didnt end there. About a year after the cocaine addiction was over with I had an accident that resulted in me being prescribed percocet. Those 2 5mg oxycodone pills not only stopped the excruciating pain from the admittedly tiny hairline fracture in my neck but also made me high as a kite. By 3 years ago I had been injecting morphine, oxy & hydromorphone/dilaudid multiple times a day. The only thing that worked to help me get (and stay) clean now for 3 years was using methadone at 130 mg per day weaned down over time to 35 mg per day. Then about 6 months ago I was given the option to switch to suboxone. I was hesitant. I gave it a shot though and I felt miserable for the 2 days I went without the methadone and another 5 days on the suboxone. Then suddenly on day 6 of the suboxone the last bit of withdrawal symptoms disappeared and I’ve felt absolutely perfect ever since. I’m currently on 20 mg of suboxone a day and I plan to get it reduced by 2 mg every 30-60 days until I am on such a small dose that I can start to be weaned off of it with the help of stuff as weak as tylenol and imodium. This is what my friend recommended, as it is what he said finally worked for him after 10 years of being an opiate addict (he has been 100% clean and sober from everything including alcohol since 2005). I may have “substituted one opiate for another” but you know what? I’m not stoned every day (nor could I be if I wanted to as suboxone can’t make you high with daily use, also stops other opiates from working and it cannot be injected or crushed and sniffed. It also has a ceiling effect so no amount will make you anymore “high” even if you were getting high off of it for the short time that would work if you didnt actually have an opiate tolerance/addiction). I’ve gained a healthy amount of weight back, I can function like any other regular person and work every day. I’m no longer sticking needles in my arm 5-10 times a day just to stop from being sick. Anyone who thinks suboxone and methadone are just swapping addictions have no idea what they are talking about. I dont care if they are a doctor or an addictions “expert”. No “expert” would openly oppose what has proven to be for millions of people the one and only way they can get clean and stay clean. But hey, God forbid someone take suboxone or methadone once a day at the pharmacy in front of a pharmacist and under strict guidelines that would get you kicked out of the program if not followed to help them lead a normal life right? They’re better off being told that the only way to get clean is to take drugs that dont help (naltrexone) and to suffer in ways that these people could NEVER understand without being addicts themselves until they decide that being high means they at least aren’t suffering a fate worst than hell until they end up dying from a fentanyl overdose from some bad snack or fake pills.

  • Neil says:

    I started using naltrexone and the Sinclair method about 6 years ago. It took about 4 or 5 months to experience the full effect but I have been very pleased with my recovery. I no longer experience alcohol cravings of any kind and now drink far less and only on certain occasions of my choosing. For me, it worked a miracle, and cured me of long-time alcoholism.

  • vicaria gruver says:

    I sincerely hope someone has reached out directly to Alison and pointed her toward some solid resources.

    Alison, I’m working on quitting too and I wish you all the best. I witnessed a friend die recently of cirrhosis and all the awful things that lead up to and come with it. I can assure you, you do not want to go through nor put anyone, especially your kid, through that.

    While I’m just getting started, I can at least share what I’m doing. I began with seeing a therapist who specializes in addiction and behavior therapy. We identified my triggers and reasons and, while they’re very legitimate, we’re identifying alternative coping mechanisms. However, the hold is strong on me so I’ve begun Naltrexone as well. This is to help me cut back and so far, so good, but I know that won’t last if I don’t take further steps. So, in one week I also begin Welbutrin to help with the severe anxiety and depression I experience when quitting and to hopefully help me curb one of my triggers, evening smoking. The goal is be off the med crutches in 6 months.

    This is not to offer guidance, just to give you an example of what another chronic over imbiber is trying. All the best!

  • Gary says:

    I did the naltrexone in oil suspension for extended release. I have been on it for 6 months. I think the only thing naltrexone did for me was to make me aware that if I tried doing any opiate/-oid medication, I would likely die of an overdose. That made me aware that failure was/is not an option.
    I did/do have significant side effects to it. I’ve noticed that I get bad headaches after the injection. My insomnia and anxiety get worse. I’ve felt depressed. It makes me feel tired. It makes it harder to exercise, and it does have significant male sexual side effects. Since I’ve been on it, my libido is just gone; sex isn’t even pleasurable any longer; since I’ve started this naltrexone, I’ve had no sex life. No, make that twice in 6 months. That included my honeymoon. I’ve had worse erectile dysfunction since I’ve been on it.
    I’ve looked online extensively, and there is zero consensus that this medication stops cravings. Some say it does; others that it does not; the product website for the FDA-approved naltrexone injections says it MAY NOT reduce cravings. So the manufacturer won’t even say if it does or does not.
    I’m not so sure this medication is all that it’s hyped-up to be.
    I found that Australia used this medication extensively, but fell out of love with it quickly. What they found was an increase of overdoses from opiates from patients that were on it. After a scathing review in the Australian Journal of Medicine, they wrote this off.
    I have found it to be inconvenient to find anyone to do this injection. Most docs do NOT want to participate in this. So I have to drive 8 hours back and forth once a month to get this shot.
    I would advise anyone who is interested in trying this naltrexone injection to first find out if your insurance will cover the FDA-approved version. They doc that did my detox knew I had prescription drug coverage, but did not tell me that I could get this covered by insurance. Instead he chose to only tell me about the “propriety blend” of this drug, and I was charged $1100 out of pocket for something that insurance would have covered. I would expect this out of a drug dealer. Finding out that the detox doctor had ripped me off in this way really took the shine off my accomplishment of getting off of opioids. So before you accept some “proprietary formulation” of ANY naltrexone product, check first with your insurance. You could save a LOT of money.
    It seems that this works mainly by blocking the opiate/-oid receptors. Well, if you’re going to use, great. But I changed doctors; my new ones know not to give me any opiates/-oids. And I don’t know anyone who uses or sells heroin, thank God. But even if I did, I would never do that. That’s why I got off the pain meds in the first place.
    So it’s locked up my receptors, great. But I have no interest in using these drugs ever again. I had been a pain management patient, and I only got my meds from a really bad doctor in Chicago and my pharmacy. There was never any “social” aspect to this problem, other than it ruined my social life.
    So I’m not sure what the benefits of this medication really are. There seems to be no consensus of opinion out there.
    In my case I don’t think any ostensible benefits to naltrexone injection outweigh the side-effects. And, yes, I would like my sex life back, please.

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