Gavril W Pasternak

REVISED BY REBECCA MARLOW-FERGUSON

NALTREXONE IN TREATMENT OF DRUG DEPENDENCE Naltrexone (brand names TrexanR, ReviaR [U.S.], NalorexR [France, U.K.]) is a synthetic antagonist of opiate (morphine-like) drugs, which blocks their actions without itself having any opiate effects. Naltrexone differs from most other pure opiate antagonists in having a relatively long duration of action (at least 24 hours) and being effective when taken by mouth. These characteristics have led to its clinical use as a long-term or maintenance treatment for OPIATE and Opioid dependence after detoxification. Naltrexone is also being studied experimentally as a possible treatment for cigarette smoking and eating disorders, and was approved in 1995 for treatment of alcoholism.

The use of opiate ANTAGONISTS as treatment for opiate dependence was first proposed by William Martin and Abraham Wikler and their colleagues at the U.S. Addiction Research Center in the early 1960s. They hypothesized that chronic administration of an opiate antagonist, by blocking the pleasurable or rewarding effects of opiate drugs, would lead to the extinction of drug-seeking and drug-taking behavior—since the addict would no longer receive any pleasurable effects from taking an opiate. With abstinence from opiates, PHYSICAL DEPENDENCE and any chronic withdrawal syndrome would dissipate, removing important factors that cause craving for opiates. They suggested that antagonist treatment would have several advantages over treatment with an opioid such as METHADONE. Since antagonists do not produce any pleasurable effects, the addict would have little incentive to misuse the medication or divert it to illegal channels. Chronic use of an antagonist would not produce physical dependence, and an overdose of antagonist would not cause life-threatening opiate effects such as suppression of breathing. Use of the antagonist in nondetoxified opioid addicts, however, would cause an acute but not life-threatening withdrawal.

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