A study published at the end of 2015 (please see this article summary) showed that opiate addicts benefited more from extended release naltrexone treatment than they previously had with Suboxone. It appears that naltrexone with psychosocial therapy significantly reduced the urge to use opiates when compared with Suboxone treatment. This and other studies (simply google: “extended release naltrexone for treating opiate dependence” for more) have also demonstrated extended release naltrexone’s efficacy in the long-term treatment of opiate dependence.
Naltrexone is an opiate antagonist that does not offer any “buzz” or addiction risks. It minimizes the impact of the effects of opiates and can also be prescribed for alcohol dependence. From my perspective, there are two (2) distinct advantages to naltrexone over Suboxone: 1) Any medical doctor that can prescribe medication can prescribe naltrexone, while Suboxone prescription requires a DEA license; and, 2) there is no risk of diversion with naltrexone, while there is definitely one with Suboxone.
Part of the problem with Suboxone is the close scrutiny doctors must endure from the feds. Many doctors whom I’ve tried to recruit as prescribing docs simply do not want the headaches associated with subs. Because of the DEA oversight, many doctors will not even bother with the licensing process; therefore, there are very few doctors that will prescribe and carry opiate-addicts as patients. This low-supply of prescribing docs has been a challenge for referrals, as there just aren’t enough docs to go around (each Suboxone-prescribing doc can only carry 100 patients). However, because any doctor can prescribe naltrexone, I can refer clients to either their primary care doctor or any medical clinic. This ability provides far more support channels than Suboxone.
Further, the lack of diversion risk makes naltrexone an even better option for referrals. Diversion is when Suboxone is traded or sold or used in any other way than it’s intended. In my experience, this is a huge problem. Suboxone has high street value and can be abused just as any other opiate. I’ve had several clients who were kicked out of Suboxone programs because they were abusing the program and diverting their meds. Since naltrexone has no street value, there’s really no point in its diversion.
There are drawbacks, of course, to naltrexone. The two (2) biggest are its cost and the fact that adherence rates are low. Also, there are physical risks to the liver associated with naltrexone and opiate-addicts with liver problems would not be ideal candidates for this med. However, these limitations should not, in my opinion, be a deterrent for extended-release naltrexone consideration. With heroin and other opioid use rates and deaths increasing, we need all the resources we can get. To learn more about extended release naltrexone, please download this SAMSHA advisory:ER-NALTREX