League Agains Intoxicants LAI - 100 year in 2004
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Scientific and Advisory Board, Eurad:


Publisert 2004-10-30

Much has been said about Naltrexone, leading in many cases to confusion. It is the aim of this report to shed some light on this topic and to introduce the layperson to this drug and its uses.

There are two similar chemical substances: Naltrexone and Naloxone. Both are generic names, the names of the chemical substance with some effects on human body and brain. In this paper I only will concentrate on one of both drugs, namely Naltrexone.


The drug is 41 years old, has appeared in the published clinical literature for over thirty years, and more than 1700 references to it are to be found in the Medline database. It is sold under the trade names Nabilon, Nalorex, Nemexine, Narcan. These denominations vary from country to country.


How it works


Naltrexone blocks the opioid receptors in the brain for 24 hours. The desired effect of injected or smoked heroine is not achieved. The consequence is that persons under the influence of Naloxone consuming opioids like heroine, morphine or codeine experience no drug effect, no high.


Therefore drug addicts begin to realise the futility of consuming opiates and learn to cope without the 'helping effects' of opiates. They learn to live, to feel, to react, to work without being under any drug influence. This is what differentiates it from  all other substitute drugs. If addicts have a relapse, they will not suffer any effect of the injected drug. Naltrexone has no subjective effects or potential for abuse and addiction.

Naltrexone was originally used to treat dependence on opioid drugs but has recently been approved by the FDA as treatment for alcoholism for a variety of reasons. Firstly, Naltrexone can reduce craving, which is the urge or desire to drink. Secondly, Naltrexone helps patients remain abstinent. Thirdly, Naltrexone can interfere with the tendency to want to drink more if a recovering patient slips and has a drink.




Naltrexone is taken orally or implanted under the skin. Drug addicts begin treatment after a successful medical detoxification in a residential setting. In order to prevent precipitating an opiate abstinence syndrome, individuals must be medically detoxified and opiate free for several days before Naltrexone can be taken. The drug is taken daily or three times a week: Monday and Wednesday 100mg, Friday 150 mg. Implants in the skin are usually effective for six-week periods.





Revival Drug Narcan (Naloxone)


Naloxone is the revival drug given to people in Emergency Rooms and Ambulances when they show symptoms of overdose. Patients immediately display withdrawal symptoms because of the blockade of the opioid receptors. This sudden sobriety, the sudden unpleasant feeling so called ‘cold turkey', often makes the patient/user very violent and they often leave the Casualty Room or scene of overdose and go back to using opiates in a matter of a few hours - or as long as it takes them to get some more drug.


Side effects


Naltrexone has virtually no significant drug interactions - other than with opiates - and combines well with the other non-opiates that our patients have to take.

In the largest study, the most common side effect of Naltrexone affected only a small minority of people and included the following: nausea (10%), headache (7%), dizziness (4%), fatigue (4%), insomnia (3%), anxiety (2%), and sleepiness (2%). These side effects were usually mild and of short duration. One serious drawback is that Naltrexone can have toxic effects on the liver. Blood tests of liver function are performed prior to the onset of treatment and periodically during treatment to determine whether Naltrexone should be started or discontinued if the relatively rare side effect of liver toxicity is taking place.

As in treatment for alcoholism, Naltrexone's side effects, predominantly nausea, have been severe enough to discontinue the medication in 5-10 % of the patients starting it. For most other patients, side effects are mild or of brief duration.

Naltrexone should not be used by pregnant women, individuals with severe liver or kidney damage or by patients who cannot achieve abstinence for at least 5 days prior to initiating medications.


Disadvantages of Naltrexone Treatment


As drug addicts remain in the social environment where they used to take drugs, it could be very difficult for them to distance themselves from other drug users and the drug scene. Therefore, they need intensive psychological help or psychotherapy during the time of recovery, further counselling and social support, employment and legal assistance.


For those who are still young and lack  self-discipline - or who are tempted by their life circumstances to take "street drugs", Naltrexone is not the optimal treatment. The risk is that addicts who mostly take several drugs continue to take other drugs like cocaine, amphetamine, ecstasy or marihuana.



Australia's leading research with Naltrexone implant treatment

For many years now there have been outpatient facilities in Australia which distribute Naltrexone to drug addicts. The results achieved are remarkable.


Naltrexone has been administered in the form of tablets. A great problem has  always been that a percentage of addicts left the treatment programme in the first months. These addicts who wanted to take heroine again, stop taking it under different purposes i.e. headache or nausea, so they had to stop taking Naltrexone. In this time the effect of Naloxone diminished and when they inject heroine, they had the desired effect of a high. So to implant Naloxone could be a good alternative, if the addict has no considerable side effects.

Australia is at the leading edge of world practice in Naltrexone implants. The National Health and Medical Research Council are currently funding a clinical trial to compare oral and implant Naltrexone treatment. Naloxone has a huge potential for treatment of heroin addiction both in Australia and world-wide. We need everyone to work together to pool all our efforts, resources and experience to examine positive options such as whether Naloxone implants might be a tool to be used to move the treatment in the direction of getting addicts off drugs.  

Recommendations of the NIDA:

Proposals made to enhance the effectiveness and expand the use of Naltrexone in treating heroin addiction included the following:

  1. In order to achieve an opioid free state required to start Naltrexone, the detoxification procedure needs to be tailored to assist transition to Naltrexone treatment.
  2. To improve medication compliance: Develop long acting delivery system, such as depot formulation of Naltrexone which lasts for up to 30 days to minimize patient decision making; co administer Naltrexone with SSRIs or other antidepressant; add special motivation enhancing behavioural or psychosocial adjuncts.
  3. To expand the use of Naltrexone in treatment: Use in special patient populations with high external motivation to remain drug free such as impaired professionals, drug-experimenting adolescents, parolees, probationers, work-release participants. etc.
  4. To improve the treatment effectiveness of Naltrexone: Educate and train treatment practioners the correct and effective way of using Naltrexone in treating opioids addicted patients.


Scientific and Advisory Board, Eurad



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