Bob, you’re naming the cultural barrier. It wasn’t that the evidence wasn’t there; it’s that “medication = cheating” was a story people told themselves. Not everyone believed it, but it slowed adoption for years. The encouraging part is that the script is finally changing. If you know someone who still thinks "pills are cheating," send them here
Because naltrexone is an opioid blocker. If someone is actively using opioids (or even has opioids still in their system), naltrexone can displace those opioids and snap the system into sudden withdrawal. That “precipitated withdrawal” is fast, intense, and miserable, and it’s completely avoidable.
So the rule is simple: naltrexone is for people who are already opioid-free (usually 7 to 10 days). Clinicians typically confirm a sufficient opioid-free interval (varies by the opioid). In my practice, I will use urine testing in someone who has recently used opioids to confirm opioids are not present.
If someone is currently using opioids or is likely to need opioid pain meds soon, other options are usually safer and more appropriate.
Naltrexone combined with bupropion (Contrave) has been found to reduce food craving and promote weight loss. I have used naltrexone off-label to help reduce binge eating with some success. I think naltrexone by itself can reduce food cravings for some types of food, especially those that increase the desire to eat more (the corn chip effect), but, in general, it is not as effective as GLP-1 agonists for treating obesity.
Bob, you’re naming the cultural barrier. It wasn’t that the evidence wasn’t there; it’s that “medication = cheating” was a story people told themselves. Not everyone believed it, but it slowed adoption for years. The encouraging part is that the script is finally changing. If you know someone who still thinks "pills are cheating," send them here
Because naltrexone is an opioid blocker. If someone is actively using opioids (or even has opioids still in their system), naltrexone can displace those opioids and snap the system into sudden withdrawal. That “precipitated withdrawal” is fast, intense, and miserable, and it’s completely avoidable.
So the rule is simple: naltrexone is for people who are already opioid-free (usually 7 to 10 days). Clinicians typically confirm a sufficient opioid-free interval (varies by the opioid). In my practice, I will use urine testing in someone who has recently used opioids to confirm opioids are not present.
If someone is currently using opioids or is likely to need opioid pain meds soon, other options are usually safer and more appropriate.
Can you elaborate on why Naltrexone is not appropriate for active opioid use?
Naltrexone combined with bupropion (Contrave) has been found to reduce food craving and promote weight loss. I have used naltrexone off-label to help reduce binge eating with some success. I think naltrexone by itself can reduce food cravings for some types of food, especially those that increase the desire to eat more (the corn chip effect), but, in general, it is not as effective as GLP-1 agonists for treating obesity.