Avance Psychiatry provides treatment with opioid antagonists (“blockers”) such as long acting injectable naltrexone (Vivitrol®) or oral naltrexone (Revia®, Depade®) for opioid addiction. Naltrexone is approved to prevent relapse to opioid dependence in patients who have completed detoxification from opioids. It is combined with counseling and monitoring to facilitate recovery. Individuals should be fully abstinent from opioids for 7-10 days confirmed by negative urine toxicology before starting naltrexone to avoid precipitated withdrawal. Naltrexone is an ideal opioid antagonist treatment medication: It is a pure, potent mu antagonist that has minimal side effects. It is neither reinforcing nor addicting and has no potential for abuse or diversion. The blockade by naltrexone is highly effective in eliminating any euphoria by re-exposure to opioids.

Vivitrol® is a long acting intramuscular (IM) injection of naltrexone (380 mg) that is given once a month. It addresses the problems of noncompliance with oral naltrexone. Other advantages of Vivitrol® are bypassing the liver (“first pass metabolism”) and less dose requirements. Opioid medications are ineffective for pain management if patient is on Vivitrol®. As with oral naltrexone, Vivitrol® carries a black box warning for liver injury, although this is very rare. Patients should carry a Vivitrol® alert card to inform physicians in case of emergencies requiring pain management. Naltrexone is most useful for highly motivated patients who desire total abstinence because of external circumstances. Examples are physicians or lawyers in recovery. Other potential target populations are individuals at the experimenting stage of opioid use, or those who are in early stages of their addiction. Avance Psychiatry arranges for assessment, insurance approval, shipment, and intramuscular administration of Vivitrol® in the office for appropriate patients.

Oral naltrexone (Revia®) dose is 50 mg tablet per day and is recommended for highly motivated individuals who desire complete abstinence. Common side effects include nausea and fatigue. There is a black box warning about liver toxicity requiring blood tests to monitor liver enzymes. Non-compliance with oral naltrexone is a common problem limiting its clinical use.