Pros & Cons of Using Naltrexone for Alcoholism

Alcoholism continues to be a problem that affects Canadians across the country.

Deaths from accidental poisoning are up year over year in Canada, according to a research report released by Statistics Canada.

While these accidental poisoning statistics also include prescription and non-prescription drugs, as well as narcotics, opioids, hallucinogens, and other substances, the rate of alcohol-induced deaths among Canadians under 65 almost doubled in 2020.

In 2020, the number of alcohol-induced deaths in those aged 0-44 rose from 325 (1.6 deaths per 100,000 people in 2019) to 480 (2.3 deaths per 100,000 people in 2020). This rise was recognized in both men and women.

These statistics highlight why it’s so important that education on treatment options for alcoholism and other substance use disorders are widely available to everyone.

Naltrexone is one treatment option for alcoholism. Let’s explore what this drug is, how it is used, and how it can aid in someone’s recovery from substance use disorder.

What is Naltrexone and What is it Used For?

what is naltrexone

Naltrexone is a prescribed medication that is used as part of a comprehensive treatment plan for alcoholism, also known as alcohol use disorder (AUD), and opioid use disorder (OUD).

Naltrexone falls under the opiate antagonist class of drugs, which are a category of drugs that work by reducing the craving sensation for alcohol and eliminating the pleasurable effects (high) that come with taking opioid drugs.

With opioids, the drug works by binding to and blocking opioid receptors and reducing and suppressing cravings. You also can’t overdose on Naltrexone.

It’s important to remember that Naltrexone is used as a treatment for substance use disorders, and is not a cure. Using this drug in combination with a recovery program complete with counselling, a structured environment, and other therapies is paramount for a patient’s successful recovery from addiction.

Is Naltrexone a controlled substance?

While Naltrexone is used as part of a treatment plan for those who take substances that could be classified as controlled in most countries, Naltrexone itself is not classified as a controlled substance in Canada.

Why Naltrexone for Alcoholism?

While it was initially used to treat opioid addiction, it was approved for use in treating alcohol abuse in 1994 by the FDA, and since then has been approved by Health Canada for the same purpose.

There are numerous studies and programs highlighting the benefits of Naltrexone to treat alcoholism, such as the ContrAL Clinic in Finland, which treated over 6,000 patients with opiate antagonist medication like naltrexone to reduce their drinking levels. The program shows a 78% success rate.

But the key here isn’t that the patients stopped drinking entirely — the program is designed to reduce drinking to “acceptable social levels”, although some patients did decide to completely abstain from alcohol by the final month of the program.

The method that ContrAL used is called the Sinclair Method, which suggests that individuals take Naltrexone at least one hour prior to drinking. The Naltrexone blocks the endorphins that are normally released when drinking, so the rewarding feeling or “buzz” is removed from the experience.

The idea is that over time, Naltrexone helps your brain disassociate the pleasurable experience you feel with drinking alcohol, resulting in you naturally wanting to reduce your consumption over time.

While the research behind taking opiate antagonist medication like Naltrexone for alcoholism is before interesting, remember that it isn’t a complete solution without the support of a recovery program.

What are the side effects of Naltrexone?

naltrexone side effects

There are a few side effects that may present when you drink while taking Naltrexone:

  • Nausea or Vomiting 
  • Stomach cramps
  • Diarrhea
  • Muscle stiffness
  • Cramps 
  • Headaches
  • Sleep disruptions like insomnia or hypersomnia 

Typically, these side effects resolve over time.

However, it should be noted that the medication doesn’t stop you from experiencing the withdrawal symptoms associated with not drinking alcohol, which is why most still consume some alcohol (at reduced levels) while taking the drug. There’s also no risk of withdrawal symptoms from the medication itself if you stop using it suddenly.

Can you still get drunk on Naltrexone?

Yes, you can still get drunk while using Naltrexone. You’ll still experience the same effects from alcohol that you would if you were not taking Naltrexone at all, such as cognitive impairment, loss of motor coordination, decreased response time, and more. 

Types of Naltrexone 

While originally Naltrexone was only available in pill form, in April 2006 the FDA approved an injectable of this type of medication.

There are now two different types of Naltrexone available:

  • Oral (taken daily)
  • Intramuscular extended-release injection (taken every 4 weeks)

Naltrexone brand names

There are a few common brand names that Naltrexone falls under, including:

  • Revia (Oral)
  • Vivitrol (intramuscular extended-release injection)
  • Addex-1000 (Oral)
  • Naltrexone Hydrochloride Tablets USP (Oral)

Naltrexone Dosage for Alcoholism

Naltrexone is usually taken every day for at least three months. However, the exact dosage and length of time you should take Naltrexone for maximum effectiveness is between you and your doctor.

Naltrexone for Alcoholism in Canada

Naltrexone is an approved medication by Health Canada that can be used as a treatment option for alcoholism, but it is rarely prescribed. Reasons behind why are complex and many, but it seems to stem from the cultural attitude that addiction is a moral failing and not a medical problem (which is false).

While the side effects of Naltrexone are few or non-existent (at least when used for alcohol addiction) the more commonly prescribed medication called Disulfiram (brand name is Antabuse) causes severe presentation of side effects like nausea, headaches, drowsiness, fatigue, acne, and more. If you take Disulfiram after drinking or drink too soon after taking it, you can get seriously ill.

In addition, you have to go through a withdrawal period before you can start taking Disulfiram, while some prescription methods (like the Sinclair Method described above) for Naltrexone suggest taking the medication right away to slowly wean yourself off alcohol instead of going through the common side effects of withdrawal.

While the reasons for prescribing a medication that can make you seriously ill over one that simply reduces your desire to continue drinking (with no side effects if you do drink) continue to be debated, it’s clear that the overall conversion around addiction in the medical community in Canada needs to change.

Naltrexone Canada Prescription

naltrexone prescription

Like most medications, in order to get a prescription for Naltrexone in Canada, you must talk to your doctor. Naltrexone can technically be prescribed by any healthcare professional that has the authority to prescribe medications.

 However, there’s some evidence that suggests that there can be other barriers to getting this medication aside from the fact that it’s rarely prescribed (see above) such as price point.

In Ontario, for example, a prescription for Naltrexone must be paid for out of pocket unless the province approves it under exceptional circumstances. The same is the case in Manitoba and was only recently approved for the drug benefit in Alberta in 2019. 

In British Columbia, there’s been a push to get more prescriptions for medications for relapse prevention through the UBC Family Practice Resident Scholar Project. The organization created the Quick Guide to Outpatient Treatment of Alcohol Use Disorder to give physicians the important information they need to aid in prescribing medications like Naltrexone.

Other Anti-Addiction Drugs for Alcoholism

There are a variety of medications available that are used to treat the cravings associated with drug and alcohol addiction aside from Naltrexone. One of them, Disulfiram, was discussed briefly earlier in this article.

However, there are quite a few widely available prescription drugs that are used to treat addiction.

Common Anti-Addiction Drugs

  • Naltrexone
  • Naloxone (used to treat overdose)
  • Subtex
  • Campral
  • Baclofen
  • Neurontin
  • Methadone
  • Suboxone
  • Levo alpha acetylmethadol
  • Antabuse
  • Acamprosate
  • Topamax

What is the difference between Naltrexone and Suboxone?

Naltrexone and Suboxone can both be used to help lessen cravings for opioid drugs and alcohol in patients with substance use disorder. 

However, these medications differ in a few ways:

Suboxone is a combination of two different medications, Buprenorphine and Naloxone. You may have heard about Naloxone being used to treat symptoms of overdose, while Buprenorphine is often used once the withdrawal process (detox) has started to treat the symptoms associated with that process. 

These two drugs together, however, create a medication that is taken before and after detox to lessen the desire to continue using alcohol or opioid drugs.

Naltrexone falls under the opiate antagonist class of drugs, as we mentioned earlier, but the difference is that if it is taken by people who are currently using opioid drugs, it can cause serious withdrawal side effects. In those who are taking the medication for alcohol consumption, it doesn’t present the same severe side effects, but still retains the effect of lessening the desire for alcohol.

Treatment Resources for Alcoholism

treatment resources for alcoholism

If you or a loved one is experiencing substance use disorder, it’s important that you know that help is available. There are a variety of options for seeking help. For instance, private vs. government-funded treatment centres are one option that you can look at.

One resource, the Canada Drug Rehab Addiction Services Directory, provides an easily searchable database of rehab centres and addiction support services across Canada. This database includes contact information and brief descriptions of services available that can’t be found elsewhere online.

Interventions

There are two different types of interventions, called direct intervention and indirect intervention. 

Direct intervention is when friends, family, employers, and others that are involved in the alcoholic person’s life intervene and start helping the person with the support of a professional interventionist.

The purpose of this type of intervention is that the person with substance use disorder doesn’t have time to react or negotiate the situation that has been thrust upon them, rather everything is set up in advance and all they have to do is go along with the treatment that has been prepared for them.

This type of intervention can be useful for those who refuse help or are too scared or ashamed to ask for help themselves, as it removes the burden of organizing a treatment plan themselves. 

With indirect intervention, the choice of getting help ultimately lies with the addict themselves. However, professional interventionists, therapists, addiction specialists, and more will provide support to family, friends, loved ones, and even the addict themselves to start treatment. 

While the addict may refuse help in this situation, interventionalists will still be available to support the family as long as they need.

Private and Government-funded treatment centres

There are two types of treatment centres available, government-funded and privately funded. Often referred to as sober living homes, these treatment centres offer a variety of different options, programs, and methods when it comes to treating substance use disorders.

Typically, government-funded treatment centres offer one type of addictions treatment program and support, with little flexibility. Privately funded facilities, however, can offer a wider range of treatment options that are focused more on individualized care.

Naltrexone FAQ

Naltrexone is a complex medication that can be difficult to completely understand, as it has a wide variety of uses, side effects, and more.

While we’ve provided high-level information about Naltrexone throughout this article, here are some more frequently asked questions (with answers) about Naltrexone.

Does Naltrexone help with anxiety?

There is some evidence from studies that suggests Naltrexone can be used to decrease the symptoms associated with anxiety. There seems to be more research needed to confirm its efficacy for this purpose, though. As always, it’s important to talk to your doctor about using Naltrexone for this purpose.

What should I avoid when taking Naltrexone?

Naltrexone is known to have some interactions with common medications, such as certain medications that are taken for diarrhea, cough, and pain. There may be other interactions with medications as well that are well known, so it’s important to keep in contact with your doctor and inform them about any changes in how you feel when taking this medication.

Does Naltrexone make you sleepy?

It’s possible that Naltrexone can make you sleepy. Common side effects that people experience when taking this medication are dizziness, drowsiness, or a general feeling of being less alert than usual. If these side effects occur, be sure not to drive, use machinery, or perform other tasks that could result in injuries to yourself or others. Discuss any concerns you may have with your doctor while taking Naltrexone.

Does Naltrexone work right away?

Typically, Naltrexone begins working within one hour of taking your first dose. Some treatment methods, like the Sinclair method that we mentioned earlier in this article, suggest taking Naltrexone about an hour before drinking in order to help curb your consumption. 

Is Naltrexone hard on your liver?

Although it is possible to see adverse effects to the liver while taking Naltrexone, that doesn’t necessarily mean that the drug is not for you. As with all medications, your doctor will perform a risk assessment based on your current state of health and other medications that you currently take, and then make a recommendation from there.

How long can you take Naltrexone?

Naltrexone can be taken for around 12 weeks or longer depending on the patient. Although there can be an increased risk of symptoms like liver damage with long-term use, talking to your doctor and weighing the risk and benefits of this medication is paramount.

Conclusion

no to alcohol

The importance of medications to help treat those with substance use disorders cannot be overstated. Treatment programs are great, but there are barriers to entry that often prevent people from partaking, such as needing to go through the withdrawal period before entering treatment. 

Medications like Naltrexone can work to remove some of those barriers and provide a 

supportive option alongside conventional treatments like rehab centres and behavioural therapy. 

Providing more treatment options and support for those with substance use disorder is necessary to help curb the alcohol and opioid addiction crisis that Canadians face.

If you or a loved one is looking for addictions support and treatment options, the following centres have extensive experience providing these services:

  • Andy Bhatti has years of addiction expertise and personal experience backed by education from the Justice Institute of British Columbia with an addiction studies certificate, nonviolent crisis intervention program, as well as other programs in the field of Intervention Skills and Training through Canadian and American studies.
  • Canada Drug Rehab and addiction services directory is a free resource that makes it easy to locate drug rehab and detox programs throughout Canada.
  • Cedars at Cobble Hill is an addiction rehab facility that specializes in providing individualized care and programs for patients experiencing drug and alcohol addiction.
  • Sunshine Coast Health Centre is a private mental health treatment facility that provides 24-hour medical care, including psychiatry, psychology, nutrition and fitness support, specialized bodywork, and other services. The Sunshine Coast Health Centre has a record of providing high-quality care since 1991.
  • Aurora Recovery Centre offers a variety of programs geared towards the treatment and management of addiction. Their philosophy is based on the knowledge that addiction is a treatable illness, and with the right recovery management system and expert care, individuals can recover from it.

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