Julia M Aharonov, DO  
Female, 55
Pontiac, MI

Specialties: Addiction, Drug abuse and dependence

Interests: My family
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Naltrexone therapy revisited

Jul 10, 2012 - 6 comments

Naltrexone drug therapy, an opiate blocker treatment, done after rapid detox treatment, is an essential component in achieving a better success rate for a drug free life style.  Three types of Naltrexone drug dosing are available:

Naltrexone Pellet
Naltrexone is an opiate blocker that reduces cravings tremendously.  At our drug detox center we administer Naltrexone pellet underneath the skin to delivers the medicine gradually over 2 months. This is a minor operative procedure. Naltrexone prevents opiates from getting back into the brain receptors and thus maintains abstinence for 2 months.  We recommend repeating the Naltrexone pellet implant every 2 months over a period of six to twelve months.  I say that because the patient’s thought process will take a few months to change to the new sober life style. The brain neurons require long time for healing. The implantable pellet is usually less expensive than the injectable form of Naltrexone.

Naltrexone Intramuscular Injection
Another form of Naltrexone post detox maintenance is an intramuscular injection of Vivitrol. The injection ensures protection from opiates for one month only. One intramuscular shot is rather expensive as it costs approximately $1200.00 per month. At MDS we include the Naltrexone pellet implant to ensure opiate blockade for two months into the cost of the rapid detox procedure. However, Vivitrol injection is, on some occasions, a preferred method of continual Naltrexone delivery as, for example, in instances of questionable compliance.
Vivitrol (extended release injectable naltrexone) has been approved by the FDA in October of 2010 to treat people with opioid dependence. It is the first and only once-monthly injectable naltrexone delivery system approved and indicated for the prevention of relapse following opioid detoxification. We are proud to be working closely with Alkermes, the pharmaceutical company that produces Vivitrol to help those patient who have and are willing to use their Medical Insurance to fully cover these injections for as long as one year after our rapid detox procedure ensuring sobriety.  For those patients who are willing to pay for injections out-of-pocket Alkermes is willing to help with substantial discounts, however it is still relatively costly.
Please, be certain you are getting Vivitrol after an opiate detox procedure, and not a compounded generic substitute, as the dose and the delivery mode may not be accurate. Such generic substitutes have been known to be used by some detox clinics.

Naltrexone Pill
The last method of Naltrexone dosing is the oral route. It is simple, but we prescribe it in rare situations. It is so easy to forget taking the pills by the post drug detox patient. We don’t want patients to be vulnerable as the mental thought process has not adapted yet for a drug free life style.

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Avatar universal
by Skidmore, Jul 16, 2012
sounds like a bunch of crap to me .

Avatar universal
by unkapelty, Jul 19, 2012
Sorry Skidmore, but she's right on point.  Naltrexone produces an effective blockade against opiates.  I may be inclined to take exception to the idea of implants as treatment for newly recovered opioid dependent addicts.  Naltrexone doesn't do much in the way of craving suppression and spracked out addicts have been known to grab the closest sharp object and dig their implants out so they can resume using their drug of choice...this seems extreme, but its a fact.  If you can prevent an addict from getting high, you have a chance to work on behavior modification...Naltrexone will prevent an addict, or anyone else for that matter, from benefiting from the effects of opiates.  

A weak but compelling study took a look at two small groups of Anesthesiologists treated for addiction.  These kids have it rough, they are subject to occupational exposure to opiates as a vapor mist in their work environment.  Many suffer from addiction and are unable to return to practice after treatment for that addiction.  The study took 11 doctors that went on Naltrexone and compared them to 11 doctors not on Naltrexone.  Of the group on Naltrexone, 1 of 11 relapsed on opiates as compared to 8 of 11 who did not get Naltrexone relapsing on opiates.  Furthermore, of the doctors not taking Naltrexone, only 1 successfully returned to practice anesthesiology, while 9 of the 11 doctors who took Naltrexone were able to return to practice without relapse.  This was true three and one half to four years later at the time the study was published.

So, no....it isn't really a bunch of crap.  You may be able to read the full text by searching "mandatory naltrexone anesthesiologists"  Admittedly it is a weak study of a small sampling, but I would expect similar percentages if the experiment were carried out with as many as 5000 individuals.  Oh, and that solitary doctor in the group not receiving Naltrexone who successfully returned to practice...he was primarily alcohol dependent and his opiate abuse was never verified.

Personally I like watching people using a partial agonist, specifically buprenorphine and naloxone combined.  I would like to see research work on developing a sustained release depot formulation of buprenorphine for a once monthly injection, because like Naltrexone tablets, oral compliance with Suboxone is the biggest challenge to successful treatment in an outpatient clinic...the whole - you can lead a horse to water, but you can't make him drink - frustration.  Partial agonists do not exhibit the anhedonic side effect of Naltrexone.  Because of the mechanism of action of Naltrexone and it's effect on reward pathways, people who take it report a slight lack of interest in pleasure seeking activities.

At any rate, aside from my personal preference for treating with Suboxone, I hope I have reassured you that the Vivitrol works well at maintaining abstinence from opiates in the long term.  Oh, and Touchpoints offers up to $500 a month of copay assistance, so if you have a 40% copay for medications or less...you probably won't have any out of pocket share of cost for your heady $1,200 per month medication...once you meet your deductible.  Despite how it may sound, I do not work for Alkermes nor receive any compensation from any pharmaceutical company.  I am involved in treatment for dependency and addiction, and this is all merely my opinion...except for the study info...that's all someone else's work that can be independently verified.

Good luck with your recovery,

yer Uncle Pelty

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by Ben727, Mar 21, 2013
Recent studies have shown that Naltrexone doesn't block cravings in opiate addicts as well as it does in alchoholic patients. It does, as the doctors point out above, prevent them from getting high. If an addict is using naltrexone and also trying to take opiates to get high (which are blocked), I think there's an issue with their recovery that naltrexone is not going to help with. Rapid detox doctors use naltrexone to attenuate withdrawl. Claiming that it blocks craving and assists in neural healing is not based on science (although it may well be true in some patients).

My opinion: it's just another "silver bullet" kind of approach. Fact: Any opiate addict can quit on their own, with no additional drugs, and "heal" completely through diet and exercise. They will suffer horrible withdrawl pain, and healing will take a long time and require a ton of work. And many people who become addicts don't want to deal with that concept. And this general unwillingness to deal with a difficult process opens the door for suboxone and naltrexone and methadone "treatment". If we focus on outcomes, yes, perhaps there is a percentage of patients who do, in fact, get clean long-term through one of these treatments. But those long-term success stories may well have succeeded anyway, at a much lower cost to themselves - and at the cost of reduced profits for the medical and drug industries.

Avatar universal
by DoubleInTrouble, Jan 24, 2014
Hello Julia M Aharonov
Iam a 28 yr old female dealing with alcohol and opioid addiction, have had a problem with alcohol far longer then opioid(Norco), been taking them for 1 1/2 , 4 max in a day halved, orally. Alcohol had been a problem in my life for about 10 yrs, in those then years I went cold turkey and was sober 5 yrs. Just a little briefing on myself, but I read one of ur responses from the 22nd of this month about recommending Vivitrol for a sister who was looking for help for her brother. Now getting sober is not hard for me I been 2 days sober off of opioids (which I was clean for 3 months up until the last 2 weeks ) and alcohol, staying sober is what's harder for me, I don't drink everyday , Iam a binge drinker , so it went from 1 time a month binging which lasts 3-4 days to once every week. Do u think Vivitrol would be a good thing for me to try , Iam willing to do whatever it takes except for taking other pills (Narcotics or Benzos) to replace my other addictions , because I do have bad anxiety and feel very depressed lately but I can tell it's from my alcohol and norco use. Please any advice will help.

Avatar universal
by DoubleInTrouble, Jan 24, 2014
And also is Vivitrol ( Naltrexone ) have withdrawals when stopping , addictive a narcotic , or harmful to your brains central
Nervous system ? I just don't want to go from one addiction to the next , just want my life back! I have been off it 2 days , how many days should I wait while off opioids and alcohol to get Naltrexone ?

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by Julia M Aharonov, DOBlank, Jan 25, 2014
Vivitrol injection is naltrexone and is FDA approved for both alcoholism and opiate (any opiate) addiction. The shot can be used for alcoholics without them being dry, however, you have to be clean from opiates and the amount of days depends on which opiate one is on, because of the half life of each opiate is different. What we do in our clinic is we induce rapid withdrawals under sedation and block all the opiate receptors, thus we can initiate the naltrexone therapy while the patient is still asleep. We prefer to start with a two-month implant on naltrexone which works in exactly the same way as the Vivitrol injection but allows us two months to set up for the Vivitrol delivery to the patient's home state and their doctor's office - it usually takes time as it is fully covered by most medical insurance - and gives the patient an assured two months of sobriety.  You can get more information by calling our patient coordinator at 888-637-6968.
Good luck to you.

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