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

Stanton Peele , recognized as one of the world's leading addiction experts by The Fix, 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

  • 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.

  • Lars says:

    The short answer:
    Naltrexone is a psychotrope drug in its own right. It has its place, but do you really want to use something like that in order to have a few glasses of wine on occasion?

    Also the wonders of medication are often praised as if all diseases have an “off butten” hidden somewhere in your body and that some wonderfull medication will flip that switch for you. In real life naltrexone is benficial because it will supress the function a major behavior regulation system: Naltrexone will block endorphins released by alcohol consumption AND all other causes. This will curb your enthusiasm for drinking, but can also take away a lot of other pleasures in life. And it will also make anesthesia quite complicated if or when needed.

    So it is a bit of a crude way to influence crawings for alcohol, but not entirely without merrit.

    I have written a long article on naltrexone alcohol treatment, that can be found at
    http://www.resourceaddiction.com/naltrexone-alcohol/

  • 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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