Question 1

What makes the naltrexone implant so different from currently available treatments?

Accepted Answer

Naltrexone implantable pellets provide relapse protection over several months.

Question 2

Is that because Naltrexone doesn’t allow you to get high? How does it stop overdose?

Accepted Answer

It basically works by becoming the receptors for the opioid—naltrexone kind of takes over your receptors. It’s why paramedics and others carry a shot of naltrexone to use as a rescue for someone having an overdose. 
But, for example, if someone got in a car accident or something and really needed pain medicine, you could get them to a point where you could take care of their pain. It would take a lot, way, way more than usual.

Question 3

Can you walk us through the procedure? What’s it like?

Accepted Answer

During the in-office visit, patients are taken into the exam room where the insertion site is cleaned and numbed. The most common site of insertion is the upper buttock. Once numb, a small incision is made for the pellets to be inserted. After the pellets are placed, the insertion site is covered with a small bandage. The total procedure takes less than 15 minutes.

Question 4

Can you get more than one implant? Can you keep getting them until you feel comfortable living without it?

Accepted Answer

Yeah, absolutely. there are people who have had multiple implants and there are people, who only had one implant and never touched drugs again. Then there are people who need to come back every three months and have another set of pellets inserted. One of the important differences with this implant is that people are usually more “with it” after those six months, more able to decide if they need another or feel good after one. And sometimes people fall back in and relapse and then realize they need another one. So it can be used in different ways and still provide protection.

Question 5

So once the implant is in and dissolves, there’s nothing else to do? No removal?"

Accepted Answer

No, no. That’s it. It just dissolves and there’s nothing you have to do afterward unless you were to get a second one. You know, no one sets out to have an overdose. It's something that just happens and you never know when it's going to happen. So the question is: is there something that you can do to prevent it, knowing that someone is addicted and they're at risk?

Question 6

Are Naltrexone Implants safe?

Accepted Answer

Licensed pharmacists manufacture the implant for each individual patient while maintaining the highest pharmaceutical standards. The naltrexone implant pellets have not yet been submitted to the FDA for approval, but the FDA has already approved the medication it contains.

Naltrexone in all forms is relatively safe. Initial studies suggested that it could cause additional liver problems in patients with acute liver disease such as hepatitis, but in practice it has been extremely well tolerated by most patients. Patients receiving the pellets obviously can expect slight bruising and discomfort for a short time after the simple procedure. There is also a very small risk of post procedure infection but this has not occurred in any of our patients.

If naltrexone therapy is started before the patient has significantly detoxed from the opioids, the pellet will cause severe opioid withdrawal symptoms. Also, if a patient on naltrexone therapy were in an accident where narcotic medicines are normally used for pain relief, the narcotics would have no effect.

Should the patient be injured after the procedure and require analgesia (pain medications), they must inform the doctor that he is on naltrexone maintenance therapy so an alternative medication may be prescribed. Because the patient may be involved in an accident or some other occurrence that renders him unable to inform the doctor that he is on the medication, it is recommended that he wear a Medic-Alert tag which advises the doctor that the patient is receiving naltrexone maintenance therapy.

If patients try to override the blocking effects of naltrexone and abuse narcotics they have a very unpredictable and dangerous risk of a fatal overdose. Patients also need to be especially careful after the implant wears off because they no longer have a tolerance for the drug. The same amount of drug previously used after a period of abstinence can be fatal.

Question 7

How does Naltrexone compare with opioid maintenance therapy (OMT) drugs such as methadone, Suboxone®, and Subutex®?"

Accepted Answer

Unlike these drugs, naltrexone does not have an 'opioid effect.' Because of this fact, naltrexone is allowed in most treatment recovery programs and in sober living homes. In addition, once a person is on naltrexone, they cannot get high from opioid use and they can stop without any withdrawal symptoms. Although OMT drugs can be useful in short-term detox programs, they should not be continued for an extended period. This reduces the potential medical addiction to the prescription drug that is just as difficult to quit as heroin or pain medications.

Question 8

IS NALTREXONE PELLET THERAPY A CURE TO OPIOID OR HEROIN ADDICTION?

Accepted Answer

In a word: no. We believe strongly that naltrexone pellet therapy by itself is not a cure, but during the period of its opioid blocking effects it virtually eliminates the possibility of relapse. This is the key for many addicts that want to recover but believe it is impossible when they are dealing with the daily cravings. Freedom from the cravings, and knowing there is no reward of getting high, allows the recovering addict who is 100% committed to recovery to put all of their mental focus on a 12-step program and/or professional therapy.

Studies have shown that the best indicator of long-term recovery is continued participation in a 12-step recovery program. Most addicts have not developed the life skills and behaviors required for lifelong sobriety. This is the real work in addiction recovery and one that cannot be ignored or assumed to take care of itself while enjoying the freedom from cravings. Naltrexone therapy without the appropriate therapy and 12-step support is almost always unsuccessful.

Question 9

CAN NALTREXONE ALSO BE USED FOR ALCOHOLISM RECOVERY?

Accepted Answer

The ultimate goal of recovery from alcoholism is abstinence and learning how to live without drinking. There are also a number of medicines that can assist in achieving and maintaining abstinence. Naltrexone is probably the most powerful of these medicines. Naltrexone is a drug that attaches to the opiate receptors in the brain and blocks them. Part of the pleasurable effect from alcohol happens through these opiate receptors. When these receptors are blocked, people get fewer cravings for alcohol and less pleasure if they do drink any alcohol. It becomes much easier for them to stay abstinent and continue with their recovery program.

Question 10

AM I A CANDIDATE FOR NALTREXONE PELLET THERAPY?

Accepted Answer

Naltrexone would be appropriate for any opiate addict who desperately wants to stop using opiates but has never managed to stay sober for a long period. The term we use to best describe this person is that they are in a “state of readiness." A person may say they are ready to recover, however this will only be confirmed through their actions that will be obvious to their 12-step group, their therapist, their family and friends, etc. The recovering addict will consistently make life-affirming changes that demonstrate self-reliance and emotional maturity.
Naltrexone is very helpful for those that are ready but know that relying on will power or counseling alone will not work for them. Naltrexone is not a mood-altering drug and is therefore not objectionable to most recovery programs or sober living homes that require abstinence. Participation in a 12-step recovery program is the single most important form of follow-up care. We believe there is no substitute for the therapeutic value of one addict helping another to sobriety.

Question 11

WHAT'S THE PROCESS OF EVALUATION AND TREATMENT WITH NALTREXONE PELLET THERAPY?

Accepted Answer

A person needs to be free from opiates or heroin for a minimum of one week before receiving a naltrexone pellet. Those on Methadone, Suboxone® or Subutex® should be off their prescription for at least 10-14 days because these drugs take longer to clear from the body. Even if no opioids have been taken for the recommended time, there may be some mild to moderate withdrawals due to the chronic imbalance in the essential brain neurotransmitters.

We require a simple blood test, a basic screening and exam to decrease the risks and increase the success of naltrexone therapy. We will also perform a urine drug screen immediately prior to the pellet insertion.

The procedure is simple and takes just a few minutes to perform. The doctor will numb the area and then make a small incision and place one pellet (3 month duration) or two pellets (6 month) under the skin. The incision is closed with a few stitches and the patient is sent home or could even go back to work if they desire.

It is recommended that patients wear a Medic-Alert tag (bracelet or necklace) that would inform a treating physician that the patient is on naltrexone maintenance therapy in the event that the patient is not able to communicate this information. The physician would obviously need to prescribe a non-opiate medication if pain relief was required.

There are very few side effects from naltrexone and none of them are serious. It is difficult to determine whether the symptoms that are sometimes experienced are due to the naltrexone or the last remnants of the withdrawal syndrome. The withdrawal symptoms do not occur with every patient, especially if the addict has not used drugs for an extended period. Even if the patient experiences some withdrawal symptoms, they are generally mild compared to acute withdrawals experienced during drug detox, and cease within a week or so.

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