Naltrexone

Naltrexone can work for a wide variety of people with opioid use disorder, but it may work best for someone who prefers not to take a daily opioid “replacement” medication or someone who has already abstained from opioids for a period of time.

Evidence for the intervention

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 can work for a wide variety of people with opioid use disorder (OUD), including adolescents, pregnant persons, and older adults. Based on its unique properties as an opioid blocking medication, naltrexone may not be best suited for individuals with ongoing daily opioid use or who currently take opioids for pain. Taking naltrexone for the first time requires someone to undergo a period of medically supervised withdrawal, so it is only suitable for individuals who are already abstaining from opioids or are willing to go through this withdrawal process. When used for the treatment of OUD, naltrexone is only available as an injection; it therefore only works for individuals who are willing to receive an injection on a monthly basis.