Client/Patient
Client barriers and facilitators for the use of naltrexone for opioid use disorder often relate to individual beliefs about taking a medication for opioid use disorder or preferences for which medication to take.
Barriers
Before receiving naltrexone for the first time, individuals must either undergo a period of medically supervised withdrawal or otherwise already be abstinent from opioids for a period of time, which can be uncomfortable and inconvenient. Individuals, therefore, express apprehension about starting naltrexone for the first time, and research studies show that successful initiation and retention in naltrexone treatment is lower than buprenorphine and methadone.
When used for the treatment of opioid use disorder, naltrexone is available only as a long-acting monthly injection. This can be a barrier for individuals who do not like the idea of receiving an injection or prefer taking medication by mouth.
Naltrexone is a long-acting medication that blocks the effects of opioids in the brain and body. For many patients, this is seen as an undesirable feature of naltrexone because the removal of opioid effects can be unpleasant, especially compared to medications that maintain a steady level of opioid effects in the body, such as buprenorphine or methadone.
Facilitators
Some patients view naltrexone’s opioid blocking properties as a barrier. However, naltrexone can be suitable for individuals who prefer not to take an opioid “replacement” medication.
Patients who dislike taking a daily pill or have trouble remembering to take their medication may prefer the convenience of a monthly dose of naltrexone. Patients who do not have scheduling, employment, or transportation flexibility are also likely to prefer naltrexone over medications that require frequent, supervised dosing, such as methadone.