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WHAT IS NALTREXONE?

Naltrexone is a drug that blocks the effects of heroin and methadone (Physeptone) and all other opiates, such as morphine, Palfium, codeine, dihydrocodeine (DF118) and Subutex (buprenorphine).

HOW MUCH IS TREATMENT?

HOW DOES IT WORK?

WHY TAKE IT?

HOW EFFECTIVE IS IT?

HOW LONG DO I TAKE IT FOR?

IS NALTREXONE ADDICTIVE?

IS IT A NEW DRUG?

DOES IT HAVE SIDE EFFECTS?

Very few and none of them serious. A few patients experience slight tiredness or indigestion. Even swallowing a whole bottle of tablets causes no harm. However, if you take naltrexone while you are physically addicted to heroin and other opiates, it will cause withdrawal symptoms within a few minutes. If you stop taking naltrexone and start using heroin again, you could kill yourself if you took your usual dose of heroin right away.

WHO SHOULD THINK OF TAKING NALTREXONE?

IS COUNSELLING NEEDED AS WELL?

We advise all patients to attend, or have telephone consultations, two or three times during the first month and at least every month or two for the next six months. Some people may need to come more often but if you stay clean for a few months and keep yourself occupied, a lot of your problems will probably disappear without much help. We like to involve your family in treatment. If you already have a counsellor, we are happy to work with them. NA (Narcotics Anonymous) have told us they don’t mind people attending NA meetings while on naltrexone.

CAN ADDICTS GO STRAIGHT FROM HEROIN OR METHADONE TO NALTREXONE?

WHAT HAPPENS IF I STOP TAKING NALTREXONE AND RELAPSE?

HEALTH INFORMATION FOR PATIENTS USING NALTREXONE IMPLANTS

Please read the following information carefully

If you have a Wedgewood naltrexone implant, you don’t need to take naltrexone by mouth until the implant wears off. We advise that a second implant, if you are having one, should be inserted between 4-5weeks after the first one to try to ensure that there is some overlap between implants. If it turns out that your implants last longer than the average of around 6 weeks, subsequent implants can be put in at slightly longer intervals. (Alternatively, consider an O’Neil longer-acting implant). If you feel confident that you would take oral naltrexone reliably after the first one or two implants, you should take one tablet daily or two to three tablets every two or three days. Please arrange to take naltrexone tablets under supervision, preferably dissolved in coffee or juice to discourage cheating. People taking unsupervised naltrexone tend to stop it too soon and are much more likely to relapse. If you are running short of naltrexone, half a tablet daily will probably still provide adequate opiate blockade.

Patients with an implant should make sure they keep a small supply of naltrexone tablets as an emergency reserve. This can be used if there is an unexpected delay before the next implant or if a prescription for tablets gets delayed. Implants of any type occasionally get infected. Usually, this clears up quickly with antibiotic treatment but an abscess could develop and the implant could be lost if the abscess bursts. This seems to be very rare. If it does happen, you should take oral naltrexone half to one tablet daily and seek further advice from us immediately.

IMPORTANT WARNING !!

Naltrexone implants and naltrexone tablets taken regularly seem able to block even large amounts of heroin or other opiates. Many patients test out the blockade in the first few days and are reassured to find it works. However, it can be dangerous to try to overcome the blockade by using enormous amount especially when the implant may be starting to wear off, i.e. any time after about five weeks, because you could be at serious risk of a potentially lethal overdose. When you have been clean for a few weeks, you lose your tolerance of opiates. That means that even quite a small amount of heroin could kill you if you were not protected by naltrexone. Abstinence from opiates has risks as well as benefits. There is a sad and steady trickle of overdose deaths in patients who had been clean for weeks or months and thought they deserved a little treat. DON’T LET THIS HAPPEN TO YOU.

Being on naltrexone means that opiates will be ineffective for pain relief if you have an accident or need surgery. Fortunately, there are pain-killing drugs which are not blocked by naltrexone. These include nitrous oxide (laughing gas) which most ambulances carry and the anaesthetic drug ketamine. Make sure that you always wear your naltrexone warning card and/or wear your warning tag.

Swelling at the implant site two or three months after insertion sometimes occurs. It is usually painless and usually settles without treatment. Very occasionally, infection or tissue reaction at the implant site could lead to a hole or ulcer forming in the skin. This could require surgical treatment but we stress that serious reactions seem to be very rare. Phone us if you are worried.

CARE OF THE IMPLANT SITE

It is very important to avoid soaking the incision and dressing for at least the first four days. Take showers rather than baths and protect the dressing against water. Change it if it gets wet. Please telephone us you think you are developing any infection or other reaction at the implant site. It is normal for the area to feel bruised and tender for a few days but persistent throbbing pain, redness and swelling, or discharge from the wound, suggest that infection is developing. Allergy is rare but not unknown.

REMOVAL OF STITCHES

Different doctors use different types of sutures (stitches) to close the implant incision depending on what they are most familiar with. Sometimes the sutures may be underneath the skin and do not need to be removed. It the sutures are visible, then they should be removed after a minimum of 7 days and preferably not more than 14 days, to reduce the risk of localised infection. We can remove them during follow-up visits. Alternatively, your GP can remove them, or we can tell you how to do it yourself.

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