Naltrexone is often used in psychiatric mental health care for many reasons related to addiction and/or impulse
control. It is also occasionally used to help patients with self-harm behaviors or weight loss. Considering the
mechanism of action of naltrexone, how does it aid in addiction treatment?
Addiction to drugs is a disorder and without medical assistance, most people who suffer from drug abuse
cannot recover. According to the American Psychiatric Association addiction is a complex condition where the
person will compulsively use the substance despite harmful consequences. In opioid addiction care, there are
three equally essential components: medication, counseling, and family support.
Naltrexone blocks u-opioid receptors and u-opioid receptors contribute to the euphoria and “high” of heavy
drinking. Since naltrexone is a u-opioid receptor antagonist will block the enjoyment of heavy drinking and will
increase abstinence by its actions upon reward circuitry (Stahl, 2013).
Substance Abuse and Mental health Services Administration stated that Naltrexone is a medication approved
by the Food and Drug Administration to treat both opioid disorder and alcohol use disorder. The medication is
available in pills to form for Alcohol Use disorder or as an extended-release intramuscular injectable for either
opioid use or alcohol disorder. Naltrexone is not an opioid, is not addictive and if stop its use will not cause
withdrawal symptoms. Naltrexone blocks the euphoric and sedative effects of opioids such as heroin,
morphine, and codeine. The medication specifically binds and blocks opioid receptors reducing or suppressing
opioids craving. Stahl, S. (2013) stated that a patient taking naltrexone will not get the buzz or enjoyment out of
intoxication, so it might stop after a few drinks or even become abstinent for several days again in case of drink
over the naltrexone.
Compare and contrast methadone and buprenorphine for substance abuse treatment. For this discussion,
addiction use (what substances) include the mechanism of action, contraindications, and the pros or cons of
each option.
Methadone
This medication prevents withdrawal symptoms and reduces craving in people addicted to opioids.
Mechanism of action
According to the Food and Drug Administration, methadone hydrochloride is a mu-agonist, a synthetic opioid
analgesic with several actions similar to morphine. The most famous of which involve the central nervous
system and organs composed of smooth muscle. Besides, methadone acts as an antagonist at the N-methylD-aspartate (NMDA) receptor.
Contraindication
It is contraindicated in patients with a known hypersensitivity to methadone hydrochloride or any other
ingredient in Dolophine. Also, as in any other situation where opioids are contraindicated such as patients with
respiratory depression, and in patients with acute bronchial asthma or hypercarbia.
Pros or Cons
According to American Addiction Centers, One of the benefits of patients using methadone is reducing their
use of alcohol and any other drugs, as well as a reduction in infection disease due to stopping opiate abuse
specifically injection drug abuse. Also, reduction in criminal activity due to stopping illicit drug use, quality life
improvement, improve social functioning, a better chance at long term recovery success and better
participation in addiction treatment since withdrawal symptoms are not a distraction. According to Aspen Ridge
Recovery Lakewood, methadone has controlled access which makes it lower risk of abuse. Some areas have
public funding which makes easier access or more cost-effective for some patients. Methadone is good for
patients with less self-control because the limited access will repent temptation. A better understanding of
methadone has been used for 50 years.
On the other hand, side effects of methadone can be serious and include slowed breathing, sexual dysfunction,
nausea, vomiting, restlessness, itchy skin, insomnia, difficulty urinating, depression, and irregular heartbeat.
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Also, the long-term side effects of methadone include lung and respiratory problems. The biggest risk of using
methadone is abusing the medication because it is an opiate and can be addictive (AAC, 2020). Being
controlled is a problem as well because if patients cannot come to the clinic cannot get their dose.
Buprenorphine
Blocks the effects of other opioids, reduces or eliminates withdrawal symptoms, and reduces cravings.
According to the National Institute on Drug Abuse stated some studies have shown elevated relapse rates
among patients tapered off buprenorphine in comparison with patients maintained on the drug for a long time.
Buprenorphine can be taken as a pill that dissolves under the tongue. There are two forms Suboxone contains
buprenorphine plus another medication called naloxone. Subutex contains only buprenorphine.
Mechanism of action
According to Medscape buprenorphine is a partial agonist at the mu receptor, it can partially activate the
receptor and that is why a ceiling effect because the medication gives users analgesia, euphoria, constipation,
and respiratory depression, but to a certain limit. This means even if the medication dosage is increased the
effects do not go above our theoretical ceiling limit. Buprenorphine’s partial agonism is sufficient to prevent
craving and withdrawal symptoms. Buprenorphine has also a high affinity at the opioid receptors which means
there is a risk of precipitated withdrawal.
Contraindication
It is contraindicated with significant respiratory depression, acute or severe bronchial asthma in an
unmonitored setting or in absence of resuscitative equipment, known or suspected gastrointestinal obstruction,
and in patients with hypersensitivity to buprenorphine (FDA, 2020).
Pros or Cons
One of the greatest pros is that they reduce or eliminate withdrawal symptoms and withdrawal symptoms are
one of the biggest reasons why addicts have a hard time quitting. It is a long-acting medication which means
that after an initial period the doctor may change the dosage from one pill daily to one pill every other day.
Cons using this medication is that patients use the medication to maintain a certain level of addiction but not
able to use the drug to reduce their dependency.
Both medications are equally effective at reducing opioid use (NIH, 2020).
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