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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 ‘high’ and can also reduce cravings in a range of addictions.

For alcohol, opioids, cocaine or other substances, we can consider 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 protocol 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 (for previous implementation of the BONDS protocols at previous services).

  • 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. In nearly all countries including the UK, naltrexone implants are unlicensed and only available on a “named patient” basis.

  • Injection

    The BONDS clinic do not currently use naltrexone injections but here is some background information. Naltrexone injections are currently licensed and used in the USA. They last one month each and can give consistently much higher blood levels of naltrexone. There is a significant amount of published data for use in both formerly opioid and alcohol dependent patients. The injection is straightforward to give: it is injected into a muscle, similarly to a vaccination; 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. The BONDS clinic does not use VivitrolTM.

  • Implant

    Naltrexone implants can be effective for several months at a time and have been around for many years. Russia is currently the only country in the world to have a licensed implant. Outisde of Russia, all use of naltrexone implants is on an “unlicensed” use which means it must be on a “named patient basis”. The longest lasting implant with the most published data is the O’Neil Long Acting Implant (OLANI). This is the naltrexone implant of choice The BONDS Clinic offers. Published data on their use can be found, 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 previous iterations of the BONDS treatment programmes since 2006 (when provided by Detox5 in the past). Our medical director has overseen the use of around 3,000 implants at Detox5 in previous years, prior to the opening of The BONDS Clinic at Broughton. Whilst other services may market the same implants as lasting longer for example, The BONDS Clinic believe in safety first. We recommend that a ‘double’ OLANI should be considered as standard and it is envisaged to last on average around 6 months.*

    *Please note: There is no guarantee on the length and efficacy of an implant and this may depend on individual circumstances.

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. Treatment with naltrexone is only considered after a consultation with your medical team.

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Would you benefit from our 7-14 Day detox?

Would you benefit from our 7-14 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.

View programme model

Naltrexone with Dr Adam Beaini

Would you benefit from a Naltrexone Implant

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