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DRINK & DRUGS NEWS :: Q&AYou ask the questions - you answer the questions. Please keep your answers coming, and feel free to email a new question. Thanks to this issue's respondents for their contributions. Question:A question keeps coming up in our rehab about the drug naltraxone,
which is prescribed to a lot of clients through the criminal justice
system. Should rehabs accept people who are on naltraxone? While
it is not a mood altering chemical, do we know enough about the
dangers - and if someone overdosed in rehab, would it be our responsibility?
[Anna, Derbyshire] Your replies...Dear Anna Naltrexone is an opioid blocking drug so if you take opioids there should be no effect. I have had two rehabs turn down patients - one who was on oral and the other had an implant. They were both 12 step, and their line was that it gave protection and the person wasn't really doing it alone. Personally I don't really like it, and only prescribe it when requested - it can make you feel unwell but isn't mood altering. I personally think rehabs should accept people who are on naltrexone. It's very difficult to overdose. Dr Chris Ford, London
We would accept clients on naltrexone but it would be our policy at Broadway Lodge to withdraw it as soon as possible after admission. We have the same approach to antabuse for alcoholic clients. It is our belief that long-term recovery will be sustained through changes achieved through a greater understanding of the factors triggering drug use and not by reliance on a chemical inhibitor. New coping mechanisms offer a safer way to stay safe! As with any drug, naltrexone has its side effects, eg difficulty sleeping, anxiety, nervousness, abdominal pain/cramps, nausea and/or vomiting, low energy, joint and muscle pain, headache. Overdose is rare but can cause liver damage. We think that it is preferable to be as chemical free as possible. Hope that this helps. Pauline Bissett, chief executive, Broadway Lodge
Dear Anna Naltrexone blocks the psychotropic effects of opiates and so prevents relapses. The Detox 5 programme hinges on this medication; initially to achieve opiate-free status and then to maintain it. There is one major concern: If an individual stops taking their naltrexone and loses their opiate block, they can go back on to heroin. If they decide to go back onto naltrexone without detoxing/withdrawing first, they will have a sudden and violent withdrawal period and this, of course, can be very dangerous. The individual will be very ill if they have opiates and an opiate antagonist (naltrexone) in their system at the same time. Therefore, it is essential that the naltrexone be given under supervision. If the opiate block is maintained, there will not be the danger described above. I would have thought that naltrexone could be used safely in a rehab because it could be used under supervision. At Detox 5 we administer the tablet crushed; the patient swallows it with clear water; and then someone stays with them for 15 minutes. This ensures that the naltrexone is absorbed. If someone takes heroin on top of this, they will not have any psychotropic effects but are obviously still susceptible to the other dangers, ie overdoses, blood-borne viruses, etc. I hope this helps. Rebecca Burnet, Patient Services Manager, Detox 5 (www.detox5.co.uk)
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