Maintenance treatment with buprenorphine has been the mainstay of office-based treatment for opioid use disorder (OUD). However, buprenorphine is not universally effective, nor is it acceptable to all patients. Approximately 50% of patients fail to stabilize, either continuing to use opioids or dropping out of treatment. The opioid receptor antagonist naltrexone has a different mechanism of action and can benefit patients who do not benefit from buprenorphine. Naltrexone is fitting for individuals seeking an opioid-free approach to recovery as it may secure abstinence and circumvent the high relapse rates observed following opioid detoxification. Naltrexone can also be used to decrease relapse risk following discontinuation of agonist maintenance treatment, and in abstinent patients at increased risk of relapse, such as individuals released from prisons or residential programs.
This presentation is designed to help clinicians integrate naltrexone into their practice. Covered topics include: the rationale for using naltrexone in contrast to agonist approach, guidelines to select appropriate patients, clinical strategies to initiate treatment, safety concerns and management of side effects, and managing common clinical problems emerging during treatment with naltrexone. Clinical decision-making will be illustrated using case reports.
