Naltrexone injection for opiate addiction

This is the hard part. Because naltrexone blocks opioids, getting the shot while opioids are still in your body throws you into sudden, severe withdrawal.

FDA labeling says you should be opioid-free for about 7 to 10 days before the first shot. SAMHSA advises at least 7 days after short-acting opioids and 10 to 14 days after long-acting ones. That includes methadone and buprenorphine.

Naltrexone does nothing to ease withdrawal. You have to get through it first, and those days are when many people go back to using. The National Institute on Drug Abuse notes that this makes naltrexone harder to start than the other two medicines.

Many people get through this stage in medically supervised detox or a residential program, where staff can treat the symptoms and give the first shot before you leave. Your prescriber may test you before the shot to make sure it is safe.

It may be a good fit if:

• you have already stopped opioids, for example after detox, a residential stay or time in jail
• you would rather not take an opioid medicine
• a once-a-month visit suits you better than a daily dose
• you also want help with alcohol, since naltrexone treats alcohol use disorder too

It is not recommended for anyone under 18. If you are pregnant or planning to be, tell your prescriber. Buprenorphine and methadone are the recommended treatments in pregnancy.

If the waiting period sounds out of reach right now, that is useful to know. Buprenorphine can be started within about a day of your last dose.

This is the most important safety point about naltrexone, and it is easy to miss.

While you are on it, your body loses its tolerance to opioids. The block also fades toward the end of each month and disappears if you miss a shot. If you then use the amount you used before, or even less, it can stop your breathing.

There is a second danger. Some people try to beat the block by taking a large amount of opioids. That can cause serious injury, coma or death.

What helps:

• Keep your shot appointments. If you are thinking about stopping, talk with your prescriber first about what comes next.
• Tell the people close to you that your tolerance is low. SAMHSA advises this directly.
• Keep naloxone at home and make sure others know where it is.
• If you slip, do not use alone, and tell your prescriber. They have heard it before. Our page on relapse explains what to do next.

Call 911 if someone is not breathing or cannot be woken. For a crisis or thoughts of suicide, call or text 988. The SAMHSA National Helpline, 1-800-662-4357, gives free referrals at any hour.

Common side effects include nausea, headache, dizziness, tiredness, trouble sleeping and soreness where the shot went in.

Call your prescriber if the injection site becomes very painful, hard, swollen or blistered, or if it does not improve. Severe reactions are uncommon but can need treatment.

Naltrexone can affect the liver. Report stomach pain that lasts more than a few days, dark urine or yellowing of the eyes. Tell your prescriber as well if your mood drops. Low mood is a listed side effect, and it deserves care of its own.

If you ever need pain treatment or surgery, tell the staff you are on naltrexone, since opioid pain medicines will not work as expected.

When you are ready to look for a prescriber, you can find treatment in your state.