One Step Clinic is a leading outpatient addiction treatment facility in Ireland. For suitable patients Naltrexone implants are administered as part of a sustained treatment option.
Published on: Mar 3, 2016
Transcripts - Naltrexone Implants
Adding to the treatment landscape of opiate & alcohol addiction in Ireland
• Naltrexone belongs to a class of drugs known as opiate antagonists. It
works in the brain to prevent opiate effects (e.g., feelings of well-being,
pain relief). It also decreases the desire to take opiates.
• This medication is also used to treat alcohol abuse. It can help people
drink less alcohol or stop drinking altogether. It also decreases the desire
to drink alcohol when used with a treatment program that includes
counselling, support, and lifestyle changes.
• Naltrexone was synthesised in the 1960s and first used clinically in the early 1970s.
• It is an opiate antagonist that inhibits the µ-opioid receptor in the brain. It blocks the
effects of all opiates including heroin, methadone, morphine, codeine and oxycodone.
• It reduces the ‘pleasure’ or ‘highs’ associated with alcohol consumption.
• It can help patients to remain abstinent in opiate and alcohol dependence.
• Naltrexone itself is not addictive. Although it binds to the opiate receptor, it blocks
rather than stimulates. Even after several months of use, there are no withdrawal
symptoms if a patient stops suddenly.
What is Naltrexone?
•Naltrexone enters the brain and nervous system, then attaches itself to
small areas called receptor sites. It binds very strongly and is difficult to
displace, blocking receptors completely to opiates.
•These receptors are part of the complex reward mechanisms that motivate
us and lead us to repetitive behaviour. If these receptors are blocked,
craving and dependence-related conduct reduces and new, healthier
behaviours are allowed to re-emerge with time.
How does Naltrexone work ?
Types of Naltrexone?
Several research & clinical trials indicates the effectiveness of treating opiate addiction:
Risk factors for craving and relapse in heroin users treated with oral or implant naltrexone (2010)
- Number of Patients: 34-35 Heroin dependent patients - Duration of study: 6 months
- Conclusion: Implant naltrexone was better associated with reduced heroin craving and relapse than oral naltrexone
Improving Clinical Outcomes in Treating Heroin Dependence : Randomised, Controlled Trial of Oral or Implant Naltrexone (2009)
- Number of patients: 129
- Naltrexone blood levels in implant recipients were maintained above 1 and 2 mg/mL for 101 and 56 days, respectively, among men and 124 and 43 days
- The naltrexone implant effectively reduced relapse to regular heroin use compared with oral naltrexone and was not associated with major adverse events.
Naltrexone Implant for the Treatment of Polydrug Dependence : A Randomised Controlled Trial (2012)
- Number of patients: 100 heroin- and amphetamine-dependent outpatients
- Conclusion: Naltrexone implants resulted in higher retention in the study, decreased heroin and amphetamine use, and improved clinical condition for patients
• “Our experience with Naltrexone Implants in opiate addicts is that over 50% of these patients report virtually no cravings.” Dr. Peter Coleman; National
Medical Director; The Coleman Institute, USA
Naltrexone implants for opiate addiction?
Several research & clinical trials indicates the effectiveness of treating alcohol addiction:
• Naltrexone depot formulations for opioid and alcohol dependence: a systematic review (2011)
- The available naltrexone depot formulations have the potential to significantly improve medication compliance in
opioid and alcohol dependence.
• Naltrexone depot for treatment of alcohol dependence: a multi-centre, randomised, placebo- controlled clinical trial
- Number of patients: 315
- Conclusion: Naltrexone depot subjects also had significantly fewer drinking days during treatment and a
significantly greater abstinence rate than the placebo group
• “Our alcoholic patients treated with Naltrexone implants usually report much reduced cravings. A recent newsletter
article of mine reviewed studies that showed that Naltrexone can greatly reduce the memories of getting pleasure
from using drugs and alcohol. (Link)” Dr. Peter Coleman; National Medical Director; The Coleman Institute, USA
Naltrexone implants for alcohol addiction?
• Patients must have been detoxed from opiates prior to insertion of a Naltrexone implant and
opiate substances must have been entirely excreted from the body
• This usually takes between 5 and 10 days after it was last used, depending on the substance.
• Naltrexone can otherwise induce a precipitated opiate withdrawal that may require hospital
• For patients requiring a Naltrexone implant, a detox is not necessary. It is however important to
prepare a patient properly for a Naltrexone implant, all patients attending the One Step Clinic
will undergo extensive assessment in advance of the insertion of a Naltrexone implant.
Preparing a client for a Naltrexone implant
• The administration of a Naltrexone implant requires a minor
• A small incision is made in the lower abdomen in front of the
hipbone, the implant is inserted, and the wound closed with two -
• The procedure is performed under local anaesthetic and takes about
20 minutes. The patient is ready to leave within 30 minutes of the
How is it administered?
• Implant appear to block receptors for 10-12 weeks. A number of pharmacokinetic studies have been conducted on
implants. Naltrexone blood levels tend to be highly variable between and within patients, accounting for variations
in recorded blood levels in different studies. Blood levels have been shown to need to remain above 2mg/ml for
effective blocking of opiate receptors.
• Implants/depot naltrexone helps any motivated person, rather than just highly motivated persons
• Naltrexone acts as a platform for recovery, reduces reinforcement, cravings, relapse & increases self control
• Long-acting formulations overcome issue of poor adherence with oral naltrexone
• Research evidence that beneficial for opiates, alcohol & amphetamines
• Research evidence is accumulating rapidly from several independent sources/countries
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