Naltrexone Pellet Treatment Program

WARNING! Patients who have used buprenorphine in any form for more than 4 days may experience a delayed withdrawal following pellet insertion. A challenge test with naloxone or naltrexone does not work immediately in buprenorphine dependent patients as it does in patients dependent upon methadone, heroin, Oxycontin, Percocet, etc. There may be a delay of two to twelve hours before the withdrawal is precipitated, alerting the practioner that the patient has a buprenorphine dependency.

If it is suspected that the patient has a buprenorphine dependency, more than 4 days on buprenorphine, then the patient needs to be off the buprenorphine for a longer period of time before receiving a pellet. It should be recommended that these patients receive oral naltrexone prior to receiving a pellet. A capsule is also available that contains naltrexone and will indicate to the doctor, through a urine sample, that the patient has taken the capsule and is ready to receive a naltrexone pellet, eliminating the need for a challenge test.

TREATMENT OF ADDICTION TO OPIATES

There are many approaches to the treatment of addiction to opiates. Some of those involve maintenance for opioid replacement therapy which typically utilizes methadone or buprenorphine. Buprenorphine has also been used for many years for detoxification prior to abstinence therapy.(Alan W. Graham, MD, FACP, FASAM, et al, Principals of Addiction Medicine, 3rd Edition, Pgs. 658-663)

Abstinence therapy is usually based in cognitive behavior therapy i.e., counseling, self-help groups, group therapy. More recently CBT is used in combination with medical therapy with an opiate antagonists such as naltrexone.

Abstinence therapy is usually preceded by detoxification from opiates. A variety of methods of detoxification both inpatient and outpatient are utilized by various practitioners. Many different modalities of detoxification are accepted in the field of addiction medicine. It is up to the clinician, based upon his evaluation of the patient and his training and experience as to which modality is indicated in a given situation.

Patients frequently self select for therapy and try many different kinds of therapy. They learn about therapies through word of mouth, the internet and other forms of advertising. Patients therefore present whether to a methadone clinic, hospital, or outpatient addiction treatment center with prior knowledge of the modalities that are used at that location and they are there because they prefer to try that modality at that particular time.