Naltrexone

Naltrexone was first approved for medical use in the mid 1980s, so it’s not a new drug. Naltrexone is a “competitive opioid antagonist”, meaning it blocks opioid receptors in the brain and body. This could be overcome by a very large amount of opioid, which is why patient safety through team assessments is key. In the UK, oral naltrexone is licensed for relapse prevention in opioid-dependent or alcohol-dependent patients. One of the hardest challenges is to remain addiction-free long term. With opioids, UK services often switch a ‘bad’ opioid like heroin for a ‘better’ one like methadone or buprenorphine (Subutex), with potentially low yearly success rates at being opioid free. In general, in the UK, naltrexone is almost exclusively taken daily in tablet form, if prescribed at all. With the oral form of naltrexone, there may be temptation to stop taking it and go back to opioids whilst long-acting naltrexone can last weeks or months at a time.

How does it work?

Opioid receptors play a role in the reward system in the brain, meaning that blocking them with naltrexone may reduce the pleasurable ‘hit’ and can also reduce cravings in a range of addictions.

For alcohol, opioids, cocaine or other substances, we can start naltrexone at an early stage following a comfortable detox*. Many detox programmes may run over several weeks before removing the primary drug addiction. A lot of patients may not be able to tolerate a lengthy withdrawal and the dropout and success rates may be highly variable. The BONDS Clinic method balances time and comfort in an individualised way to help you improve your chances of detoxing quickly, safely and effectively with real-world success rates.

  • Oral

    Following a successful detox, oral naltrexone may be used to support relapse prevention in both the NHS and private sector. In the cases where there is a risk of missing doses of daily tablets, there is an option of long-acting naltrexone implants. In the UK, oral naltrexone is licensed for use in alcohol or opioid misuse.

  • Injection

    Naltrexone injections last one month each and can give higher blood levels of naltrexone. They have published data for use in opioid patients and alcohol misuse. The injection is straightforward to give: it is injected into a muscle, similarly to a vaccination, but instead of a vaccination being injected into the arm, naltrexone is usually injected into the buttock muscle. The monthly injections are only licensed in the USA at present, under the brand name of VivitrolTM.

  • Implant

    Naltrexone implants come in shorter and longer-acting forms. Naltrexone implants have been around for many years. They are currently licensed in Russia but probably the most famous one worldwide is manufactured in Australia, and there is published data on their use, for example in the British Journal of Psychiatry.
    (reference: Kun⊘e, N., Lobmaier, P., Vederhus, J., Hjerkinn, B., Hegstad, S., Gossop, M., Waal, H. (2009). Naltrexone implants after in-patient treatment for opioid dependence: Randomised controlled trial. British Journal of Psychiatry, 194(6), 541-546)

    Naltrexone implants have been used in the BONDS treatment protocols since 2006. Our medical director has overseen the use of around 3,000 implants. For safety and efficacy, we insert two implants at a time to increase the chances of the implant lasting either 3 months or 6 months depending on the type of implant, occasionally longer. The same implants may be marketed by some manufacturers or other providers as lasting longer than 3 or 6 months (even for single implants rather than the double-implants we use) but our extensive experience has been with double implants, in line with manufacturer recommendations.

About the implant

Naltrexone implants may help with the challenge of potentially missing doses of naltrexone tablets. The slow-release pellets are placed in the fatty part of the abdomen under local anaesthetic like a minor surgical day-procedure. This can be particularly helpful for relapse prevention, creating the opportunity to stay abstinent and provide vital time needed to work on mental health and wellbeing.
For our patients with opioid misuse, those who received a naltrexone implant reported being 100% opioid free at 3 months and over 75% at 6 months*.

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*(Audit data from The Bonds clinic, 2019-2020). Past performance is no guarantee of future results

Would you benefit from our 7-Day detox?

Would you benefit from our 7-Day detox?

Our programme model is tailored to the individual’s needs. Our detox varies depending on whether the substance is a lone problem or is accompanied by misuse of other substances, the amount the patient is using, and if there any underlying mental health issues. The internal audits of the BONDS treatment protocols of many years have shown that approximately 70% of patients with alcohol or substance misuse also have an underlying mental health disorder. This combination of addiction and a mental health disorder is called Dual Diagnosis. A typical detox program at The Bonds Clinic consists of a 7-14 day with dual diagnosis assessment, then an out-patient consolidation & relapse prevention stage including talking therapy, and often includes Naltrexone therapy.

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Naltrexone with Dr Adam Beaini

Would you benefit from a Naltrexone Implant

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