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deleted1139416
Disulfiram is avoided because patients have to be motivated to take it in the first place. How is this not the same with naltrexone as well? Couldn't a patient just decide not to take it?
Why is disulfiram NOT used for alcoholism but Naltrexone is okay for opioid use disorder?
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Completely different mechanisms for how they work. Disulfiram makes you sick. Don’t wanna be sick but wanna drink? Just don’t take it. Naltrexone actually reduces your cravings and continues to work even if you relapse.
You shouldn’t use naltrexone for alcoholism if you are also using opioids therapeutically
You shouldn’t use naltrexone for alcoholism if you are also using opioids therapeutically
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deleted1139416
Naltrexone works by lowering the euphoria of opiates. So even if they work differently, the point is that patients need to take it in order to reduce the effect of the substance they are abusing, so they can just elect to not take it anymore.
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You’re right, but reducing euphoria is more pleasant than causing nausea. That’s a big reason. Also naltrexone is often given IM once a month. Harder to not take, especially if you ran into legal trouble with opioids. Your parole officer finds out if you didn’t show up
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Buprenorphine and methadone are more commonly used for OUD, and naltrexone more commonly used for AUD, though it is of course still used for OUD.
The simple response is that for the first part, no medication will work if the patient isnt highly motivated to stop using. Now when a patient has a really awful reaction while using the medication, hes likely to stop the medication rather than stop the illicit substance use. On top of that, its not helping with prevention of cravings which we want the patient to have reduced desire to use in the first place. The reaction with disulfiram can be quite severe for some people. In the same sense, i had a patient referred to me where a FM resident started her on naltrexone, but the patient was using kratom. She had an awful reaction and that traumatic experience is enough for her to not want to use that medication again.
The simple response is that for the first part, no medication will work if the patient isnt highly motivated to stop using. Now when a patient has a really awful reaction while using the medication, hes likely to stop the medication rather than stop the illicit substance use. On top of that, its not helping with prevention of cravings which we want the patient to have reduced desire to use in the first place. The reaction with disulfiram can be quite severe for some people. In the same sense, i had a patient referred to me where a FM resident started her on naltrexone, but the patient was using kratom. She had an awful reaction and that traumatic experience is enough for her to not want to use that medication again.
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