· After Suboxone has not been taken for one week and the urine drug screen is negative for it, naltrexone can be started. Option 3: · Start on Suboxone · Have regular discussions with your doctor about the duration of treatment and if it is mutually decided that you need to stay on Suboxone indenitely, make sure you are on the lowest dose that would control opioid cravings. Option 4: · Go through opioid withdrawal and go with abstinence-based therapy, meaning no Suboxone and no naltrexone. · I am not in favor of this option as the patient is unprotected in dealing with a disease and because oral naltrexone is cheap and eective in the motivated patient. e lives of millions of opioid addicted patients have been transformed after their entry into programs that treat opioid use disorder. And being the instrument of such a massive change in people’s lives has been, by far, the most humbling and gratifying experience in my life. Dr. Islam is medical director of UMADAOP of Lucas County and is board-certied in Addiction and Family Medicine. She has over twenty-ve years experience in Addiction Medicine and has worked in all phases of treatment, from inpatient to intensive outpatient, residential and ambulatory treatment.
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Some patients don’t want to be on an opioid like Suboxone and this is understandable. But it is important to remember that comparing Suboxone to the naltrexone pill or the shot, Vivitrol, is like comparing apples to oranges. Certain professions, like pilots or truck drivers, do not allow Suboxone and in that situation naltrexone is a good choice. Naltrexone cannot be given when an opioid is present in the system, as it will immediately put the patient in severe withdrawal. Naltrexone is started either at the start of addiction treatment or after Suboxone has been weaned down to zero. Naltrexone pill: e naltrexone pill is prescribed at 50mg daily and is inexpensive and approved by essentially all insurance companies. Naltrexone injection/Vivitrol: Vivitrol is a monthly injection and lately has been heavily promoted by its manufacturer Alkermes and its use is skyrocketing across the United States. It costs about $1200 per injection and 380 milligrams is injected once a month intramuscularly. Several court systems across the country are also concentrating on Vivitrol. It is important to understand that both the naltrexone pill and the Vivitrol injection work, the only dierence being that the pill can be stopped by the patient, but once the Vivitrol is injected it obviously cannot be removed, and its eects last one month. And even though use of an opioid while on Vivitrol will place the patient in withdrawal, patients have been known to relapse while on Vivtrol. e intense marketing of Vivitrol has led to its indiscriminate prescribing by physicians and its recommendation by the justice system to those facing court-ordered treatment and this is placing a terrible burden on our health care system. Vivitrol is not a cure-all and the naltrexone pill is just as good as the injection. Side effects of Naltrexone: e main side eects of naltrexone, both oral and injection, are fatigue, headache and nausea. Sowhat should you do? I’ll list out some options of what you can do when you enter a program: Option 1: · If the patient has not used opioids for at least three days and the urine drug screen is negative the naltrexone pill can be started. · If opioids are present in the urine, a return appointment can be made after three days and naltrexone can be started then. · naltrexone pill can be continued indenitely. · If taking the pill everyday is a problem and the insurance company covers Vivitrol, it can be tried. Option 2: · Start on Suboxone. · On return visits, try to stay on the lowest dose of Suboxone that takes care of opioid withdrawal and cravings. · After four to six months of treatment, start weaning process to zero.
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