Naltrexone

Extended-release naltrexone can only be given in healthcare settings because it is an intramuscular injection. Costs associated with supporting naltrexone implementation center around storing the medication, administering the injection, and determining whether an individual is prepared to receive naltrexone.

Naltrexone — Evidence Rating: Moderate Quality

Naltrexone is one of three FDA-approved evidence-based medications for opioid use disorder. Data supporting naltrexone comes from randomized clinical trials and observational studies. Trials have generally found that once naltrexone is successfully initiated, it is effective for reducing opioid use. However, naltrexone is complicated to initiate for many individuals because of its requirement for a longer period of medically supervised withdrawal or opioid abstinence. Both randomized trials and observational studies find that naltrexone is less effective than buprenorphine or methadone for reducing opioid use and the risk of overdose death among patients who have not stopped using opioids. Its effectiveness is more comparable to other medication options when compared after the patient has stopped using opioids. Naltrexone is more effective than not taking any medications for opioid use disorder.

Evidence-based Scale

Naltrexone is only available as a monthly intramuscular injection for the treatment of opioid use disorder. The primary costs associated with naltrexone implementation deal with supporting appropriate storage/refrigeration of the medication, administration of the injection by trained healthcare professionals, and verification of opioid abstinence, often through a naloxone challenge, to prevent precipitated withdrawal. Providers administering naltrexone injections can receive both a medication fee and a professional fee for the injection, both of which may or may not be covered by health insurance or require prior authorization.