Read the latest and greatest from our team
of incredible specialists.
Beach House Rehab Center » Blog » Naltrexone vs. Narcan: What Are They, and How are They Used for Opiate Overdoses and Treatment?
Naloxone vs Naltrexone. They are two must-have tools in the fight against today’s opiate epidemic but what’s the difference? Learn all about them here:
The scourge of opiate addiction and the heartbreaking number of overdose deaths may indeed seem like a plague. It did start slowly in 1999 and gained momentum, sweeping the country and now affecting all demographics. According to the Centers for Disease Control and Prevention (CDC), opiate overdose deaths, including heroin and prescription opiates, quadrupled since 1999, with 115 American deaths each day from an opiate overdose.
Millions using prescribed opiates to relieve chronic pain become addicted to the drug and turn to heroin as a substitute when they no longer have access to prescription opiate painkillers. According to research, nearly 80 percent of those using heroin (including those in treatment), report first misusing prescription opiate drugs. Since 1999, prescription opiate deaths from oxycodone, methadone, hydrocodone, and fentanyl have increased more than five times.
Fortunately, two medications, naltrexone and naloxone (Narcan®), can help address the opiod epidemic and prevent needless deaths from overdoses. Here’s what they are and how they are used in opiate overdoses and treatment.
If you or a love one is suffering from opiate addiction, please review our treatment program and learn how long it takes to withdraw from opiates.
The U.S. Food and Drug Administration (FDA) approved the prescription drug naltrexone to treat both opiate use disorders and alcohol use disorders. Naltrexone is used during medication-assisted treatment (MAT) programs for individuals who have undergone detoxification (detox) and have been free of opiates for a minimum of 7-10 days. It must not be used by those currently using opiates, as doing so could cause severe withdrawal symptoms. Naltrexone is available in pill form (brand names, ReVia and Depade) or injectable form (brand name Vivitrol).
Naltrexone belongs to a class of drugs known as opiate antagonists. It works by interfering with or blocking the two major effects users of drugs such as heroin, morphine and codeine seek: sedation and euphoria. Rather than activating the body’s opioid receptors to suppress cravings like the prescription medications methadone and buprenorphine do, naltrexone works to bind and block opioid receptors to reduce cravings. A plus is that naltrexone has no abuse or diversion potential.
Used as Part of a Comprehensive Treatment Plan
During treatment of opiate use disorders, naltrexone is included in the overall treatment plan and is combined with counseling, various treatment modalities, such as cognitive-behavioral therapy (CBT), and participation in social support programs and self-help groups like Narcotics Anonymous (NA).
Careful monitoring by the treatment team ensures that any medication changes necessary, as well as modifications to other aspects of the treatment plan, are implemented quickly. For example, those prescribed oral naltrexone may be transitioned to injectable naltrexone if the treatment team concludes that the injectable form of naltrexone would be more beneficial to continued abstinence. Because treatment with naltrexone reduces tolerance to opiates, clients who relapse may overdose by going back to the same or even lower doses of the drugs they previously took. For this reason, and the fact that relapse risk is greatest for the first 6-12 months following treatment, a solid relapse prevention plan will be an integral part of the overall treatment plan for opiate use disorder.
Naloxone is an ingredient most commonly known for its use in Narcan® and Evzio, which is used for the emergency treatment of a person overdosing (or suspected of overdosing) on opiates such as heroin, prescription painkillers like fentanyl, morphine, codeine, methadone, oxycodone, hydrocodone, hydromorphone, and Vicodin, as well as buprenorphine. When administered to someone experiencing acute opiate overdose, Narcan® can literally save their life. Narcan® is available as an injectable solution, and a prefilled, needle-free nasal spray. Injections can be administered into a vein (intravenously), just under the skin (subcutaneously), or intramuscularly (into a muscle). Evzio markets a prefilled auto-injection device for quicker delivery of naloxone.
Naloxone (Narcan®) is an FDA-approved drug in three formulations that reverses the effects of an overdose from heroin and certain types of painkiller medications. This life-saving drug has been used by paramedics and emergency room physicians for years with good success. The medication works by blocking the effects of drugs made from opium. The specific process is that Narcan® binds to mu-receptors in the brain, thereby reversing opioid activity in the body. Opiates use the brain’s mu-receptors to produce their effect on the brain. Since opiates slow breathing, emergency counter-action is required to restore it before serious brain damage or death occurs. Once naloxone has been administered to the person experiencing an overdose, regular breathing resumes, generally within minutes.
Being able to recognize an opiate overdose (or suspected overdose) may make the difference between a life saved and a life lost. Symptoms include:
When someone is overdosing, minutes count. Quick action is necessary to save a life, including performing cardiopulmonary resuscitation (CPR). Anyone attempting to resuscitate an overdosing person must ensure they know how to do it effectively. A pharmacist or doctor can train family members, patients and caregivers how to safely administer Narcan®. In addition, the Harm Reduction Coalition lists detailed instructions on the safe administration of Narcan® as a nasal spray or injectable form to someone in an overdose condition. Call 911 immediately after administering Narcan® and remain with the individual until emergency help arrives. If symptoms return before help arrives, another dose of Narcan® can be given every 2-3 minutes.
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides an opioid overdose prevention toolkit available online. This can be a valuable resource to first responders, patients, family members and prescribing physicians.
Don’t let an addicted loved one, family member or friend become an opiate overdose statistic. Education, training and a willingness to spring into action can mean all the difference. When you know what to do and how to help someone struggling with opioid addiction, you’re empowered, confident and perhaps the best-equipped one to encourage professional addiction treatment once the crisis is past.
Two other common treatment medications for opioid addiction to substances such as heroin, fentanyl and other opiates are Suboxone and methadone. Both methadone, a once-per-day medication, and Suboxone activate the same neurological receptors as heroin, but prevent withdrawal and relapse. Controversy surrounds methadone, particularly for its use in treating opiate addicts in the criminal justice system, as critics say it’s substituting one addictive drug for another. Methadone can be sold and has been linked with abuse. Some patients enter drug rehab for methadone abuse.
The injectable form of naltrexone, on the other hand, which the FDA approved in 2010, is a once-monthly injection, and is now used in some drug rehab treatment facilities as an alternative to Suboxone and methadone in treating opiate addiction. A University of Pennsylvania School of Medicine study in 2016 found that naltrexone is a viable treatment for heroin addicts, especially those in the criminal justice system considered at high risk of relapse. Results showed no overdoses and lower relapse rate than patients with usual treatment and researchers called for long-term studies of the effectiveness of treatment with extended-release naltrexone.
A separate NIDA clinical trial conducted between 2014 and 2016 compared treatment effectiveness of extended-release injectable naltrexone (XR-NTX) with Suboxone (sublingual buprenorphine and naloxone), and found that both were safe and effective overall, although it was more difficult to initiate patients into the injectable extended-release naltrexone. 24-week relapse events were similar for across groups in the study, while opiate craving was initially less in XR-NTX and converged with Suboxone by week 24, and mild-to-moderate injection site reactions occurred with XR-NTX. There were five overdoses with XR-NTX and three with Suboxone during the clinical trial. The study results called for future work on facilitating induction into XR-NTX and improving treatment retention outcome for both medications.
Hailed as an opioid dependence treatment medication that may replace other older or currently-used medications, naltrexone has its pros and cons, just as most other medications do.
Among the notable benefits for using naltrexone:
Some of the cons for naltrexone use include:
With the potential to save a human life from opiate overdose, reversing the effects of opioids, Naloxone is legitimately considered a “miracle” drug. Still, naloxone hydrochloride (Narcan) has a list of pros and cons to keep in mind.
Why is Vivitrol the preferred treatment approach for some individuals in recovery? Vivitrol has been used to treat dependence on both opiate drugs and alcohol. The drug only affects the way the body responds to the narcotic drugs or alcohol, helping prevent relapse by turning off receptivity in the brain to the pleasurable effects of the substances.
The medication should only be administered by a healthcare provider as an intramuscular gluteal injection. According to the drug manufacturer, Alkermes, Inc., Vivitrol must not be injected subcutaneously or intravenously.
Side effects and adverse reactions to medications, including those used during MAT therapy for opiate dependence should always be explained to the patient.
Side effects of Naltrexone (Vivitrol) include:
Serious side effects include blurred vision, rapid heartbeat, difficulty breathing, hallucinations, confusion, thoughts of suicide, dark urine, clay-colored stools and jaundice.
Adverse reactions of Naltrexone (Vivitrol), occurring in less than two percent of opiate-dependent patients include:
Side effects of naloxone (Narcan) include:
Narcan adverse reactions include:
For related information, see these articles:
Sources:
Centers for Disease Control and Prevention. “Understanding the Epidemic,” “Drug overdose deaths in the United States continue to increase in 2015.” Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html
Drugs.com. “Naloxone Side Effects.” Retrieved from https://www.drugs.com/sfx/naloxone-side-effects.html
Drugs.com. “Naltrexone.” Retrieved from https://www.drugs.com/pro/naltrexone.html
Harm Reduction Coalition, “Administer Naloxone: Overdose Response.” Retrieved from http://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/responding-to-opioid-overdose/administer-naloxone/
Lancet. “Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label randomised controlled trial.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29150198?dopt=Abstract
National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA). “America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.” Retrieved from https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2014/americas-addiction-to-opioids-heroin-prescription-drug-abuse
National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA). “Federal Efforts to Combat the Opioid Crisis: A Status Update on CARA and Other Initiatives.” Retrieved from https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2017/federal-efforts-to-combat-opioid-crisis-status-update-cara-other-initiatives
National Institutes of Health (NIH), National Institute on Drug Abuse (NIDA). “Opioid Overdose Reversal with Naloxone (Narcan, Evzio). Retrieved from https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio
New England Journal of Medicine. “Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders.” Retrieved from https://www.nejm.org/doi/10.1056/NEJMoa1505409
Partnership for Drug-Free Kids. “How to Use Naloxone to Reverse Opioid Overdose and Save Lives.” “Where can I get naloxone?” Retrieved from https://drugfree.org/article/overdose-response-treatment/
Prescribers’ Digital Reference. “naloxone hydrochloride – Drug Summary.” Retrieved from http://www.pdr.net/drug-summary/Narcan-naloxone-hydrochloride-3837
Substance Abuse and Mental Health Services Administration (SAMHSA). “Clinical Use of Extended-Release Injectable Naltrexone in the Treatment of Opioid-Use Disorder: A Brief Guide,” “Monitoring Patient Progress and Adjusting the Treatment Plan.” Retrieved from https://store.samhsa.gov/shin/content/SMA16-4742/SMA16-4742.pdf
Substance Abuse and Mental Health Services Administration (SAMHSA). “Naltrexone,” “How Naltrexone Works.” Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone
Substance Abuse and Mental Health Services Administration (SAMHSA). “SAMHSA Opioid Overdose Prevention Toolkit.” Retrieved from https://store.samhsa.gov/shin/content/SMA16-4742/SMA16-4742.pdf
Vivitrol. “Vivitrol. [naltrexone for extended-release injectable suspension].” Retrieved from https://www.vivitrol.com/content/pdfs/prescribing-information.pdf
WebMD. “Treating a Drug Overdose With Naloxone.” Retrieved from https://www.webmd.com/mental-health/addiction/drug-overdose-naloxone#1
"*" indicates required fields