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Treatment oral naltrexone and precipitated withdrawals

simco

simco

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Joined
Aug 20, 2014
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hey all. it's been a while (loong story that i'm happy to discuss via PM)...long stint in the psych ward, etc.

also, i know there's info related to this topic scattered throughout BL, but i haven't found anything spot on and am functioning at a pretty low level, so i hope you kind folks will bear with me.

i have a question about precipitated withdrawals induced by taking oral naltrexone. here's the timeline containing the events i'm curious about...question to follow.

Thursday (four days ago), 8:00 a.m. -- last time I used heroin (a slightly larger than usual dose for me, though not huge).
Friday, 8:00 a.m. -- i took my first ever oral naltrexone pill, hoping it would help me kick.
Friday, 8:20 a.m. -- the most awful withdrawals i've ever had came on. the symptoms were typical, just really hard and they came on like a freight train.
Friday, rest of the day -- i feel like absolute garbage, dopesick as all get-out. I don't sleep Friday night.
Saturday -- i feel a bit better, but still can't hold down food and am chilled to the bone all day. awful depression continues.
Sunday (i.e. today) -- i feel a bit better still, but still nauseous, lethargic, and cold.
Monday (tomorrow) -- ???

so it seems pretty clear to me that i took the naltrexone too soon after using, and i went into precipitated withdrawals. but there are a few things here that don't make sense to me. most of what i've read suggests that pws usually abate within hours if not even faster. (but it's also the case that most of these events seem to be in the context of buprenorphine, not naltrexone...not sure if that makes any difference).

i guess my question is, does anyone have any idea what might be going on with the protracted symptoms?

fwiw, my best guess is that the first x hours of wds were indeed "precipitated" by the naltrexone. but since i wasn't taking any kind of opiate (including bupe) afterwards, maybe i just slipped from the initial "precipitated" wd into a more "standard" wd. does this interpretation make sense to anyone?

according to my doc, i'm supposed to start the naltrexone again tomorrow. i'm scared as hell to do it. but i haven't used, and i'm determined to get onto a consistent naltrexone regimen to bolster my recovery. any insight would be much appreciated. it would help calm me down about trying the meds again.

thanks. peace.
 
Some questions:

  • What have you been taking other than naltrexone and burpenorphine?
  • Substances, drugs, medications, supplements, whatever?
  • What quality of rest are you getting?
  • Are you eating normally?

It sounds like your stress level has been really high recently. I would really try to do everything you can to relax and let your body slow down. Your body's neurobiological systems will self-regulate if only you give them the space and opportunity to do so.

May you start feeling better ASAP!
 
I don't know your backstory simco, but I'm confused on whether you had been using H steadily or had been tapering down on buprenorphine to a low level and are now using naltrexone to tail it off or some combination of both. A clarification there will help.

As an opioid antagonist, naltrexone will make any recent opioid user extremely ill when administered, and a few people I know took the vivitrol implant, which releases naltrexone slowly, and reported great and lasting discomfort from it. They all promptly relapsed too, after the last implant wore off.

To answer your main question, your symptoms are protracted because, well, you're in withdrawal. Either the naltrexone interfered with the natural reduction in blood plasma that your buprenorphine would have undergone, or it knocked all the H off your receptors in a dramatic way. Even had you gone cold turkey, assuming you had a dependence, you'd be in withdrawal then and now.

Remember Naltrexone only blocks the binding sites (and by extension the effects) of opioids, it doesn't negate the craving or cure the effects of discontinuation. It's actually a really bad way to quit, I hate to put that out there and even sow the seed of altering your path or putting the idea to disobey your doctor in your head, but it really is bad. According to Wikipedia, the FDA only approved naltrexone for opioid detox therapy based on a single study out of Russia which is riddled with problems.

What do you and other BLers think about stopping taking it? Are you dead-set on quitting and in the right situation where you can't, or better yet, won't get any more of your DOC? If so, you might have other options.

Edit: Sorry, your last paragraph totally states you want to keep taking it. Is your doctor giving you anything else to help along with it? It might help to ask for gabapentin or clonidine. They're not really abusable drugs and really help with many symptoms.
 
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Currently using Naltrexone for the last 2 months, had initial symptoms but nothing to that level however was 8 days clean before I started taking it. I'd keep with it, it gets easier and for me at least has been working wonders.

I will second Phil's suggestion above to talk to your doc about Clonidine. I personally take 100ug orally about an hour before I want to sleep, if nothing else it helps with slowing down. Clonidine is a blood pressure medication that is traditionally prescribed outside of blood pressure problems to kids with ADHD to help them shut down so they can sleep.

Happy to offer some more in-depth insight if you want to shoot me a PM.
 
Thanks, all--I appreciate your insights. Also, sorry for any confusion I sowed in my original post. I didn't write it very well; I was so sick at the time.

First an update. Then a couple clarifications.

Update: It's now a week exactly since I took my first dose of naltrexone, the one that brought all the trouble. On my doc's advice, I waited four days before trying again. When I did try again with the naltrexone, I had no problem at all. I've now taken three doses and have seen no adverse effects whatsoever (excluding that awful first time, obviously). So it seems pretty clear to me (and my doc) that the bad experience was due to my retarded decision to dive into the naltrexone only 24 hrs after using. And as Phil put it above, I continued to feel like shit because, well, I was in withdrawals. i.e. The whole experience was probably an ordinary WD, but one that began with a particularly unpleasant onset. All in all, it took nearly a week, but I feel fine now, at least physically. Yesterday was my first day feeling healthy again.

Clarifications: Before I took that first naltrexone dose, the timeline looked like so:
* ~ 4 years of heroin use. I was able to keep my habit small (50-75mg of #4 IV). But by the end, I was a daily, injecting user.
* 7 weeks completely clean. When I was in the hospital, I detoxed and cleaned up entirely.
* 3 weeks relapsed, back on heroin. This episode started small. But the last week had me back to my old regimen for 7 days in a row.
* 24 hours abstinent. I wasn't feeling any WDs after this time, so I thought my relapse hadn't brought back a physical dependence (hence my recklessness with the naltrexone).
It was at this point that I took the naltrexone and everything went sideways.

Another clarification: buprenorphine wasn't in the picture at all. I had been on suboxone at an earlier point during the 4-year habit I mentioned earlier. But it was largely ineffective for me. i.e. subs never reduced my cravings at all; their only positive effect was as a deterrent, since I had to withhold them for a day or two before I could get high. I mentioned bupe in my initial post because most of the info about precipitated WDs on BL seems to be written in the context of initiating buprenorphine treatment, which obviously presents a different landscape from what I was facing.

Last clarification: Other substances. Other than relapsing onto heroin, I was smoking weed most days. And by Rx, I take 150mg of zoloft daily and 2mg of clonazepam daily (which I have always used as directed).

Thanks again, everyone, for helping out with the good info. I've made this post long and detailed simply in the interest of clarity. Maybe someone else will find it useful down the line.

By the way, for whatever reason, I have been able to stay clean since my initial post. I'm feeling fairly good, in fact.
 
That is awesome to hear. That couldn't have been easy and must have taken some serious muster. Good job, very inspiring for many I'm sure!
 
I am currently under going this. NOT BY DESIGN! Total brain fart. Word to wise Google always before diving in.

Small H habit. Quit 4 days ago. Spilt a 8mg strip 4/2/2 consecutive days. Took 50mg naltrexone pill last night at midnight..within the hour..omg I nearly called for an ambulance. I have kicked cold turkey many times. Nothing and I mean nothing compared to how awful this was. By 5am. My unbearable anxiety began to settle (no benzos y'all). Managed 2 hours of "sleep" got up, Googled what the fuck just happened...I had no idea. Jesus. It's 18 hours later, feel relatively well. Stomach pain at times. Lethargic. Nose run. But overall much better. Yeah don't do this without heavy sedatives/benzos and maybe an observer. I swear I was strongly considering an ambulance at the peak..about 3 hours in. Bad move. Get clean. Stay clean. Fuck this nonsense

Will update post each day for anyone it may help.
 
I'm happy to hear you're feeling good again and doing well with this med!
I went into precipitated WD but my experience was with suboxone so not really related to yours other than I can totally relate to the instant hell that is precipitated WD! I couldn't believe how fast and severe it came on... def scared me to death of ever having to go thru that process again!
But again, glad to see you back around and feeling good!
 
Sorry to hear about that, Libertine! Yeah, the precipitated WDs from ill-timed naltrexone really floored me. Not sure what your long-term plan is, but if you're planning to stay off the opiates, at least you can know that it will dissipate pretty quick. For me it just went from EMERGENCY-style pWDs to plain-ol vanilla WDs, and I was able to power through that. You will too!
 
The first time I was scripted naltrexone was well over a year after any opiate use and was to reduce alcohol craving. I would say it made me sick as shit 90% of the time I took it, giving me symptoms of opiate withdrawal. The residential rehab that scripted it for me pushed Vivitrol but I said absolutely no way Jose. I can stop taking pills, but you can't stop taking a shot.
 
Yeah, the idea of any time release injection or implant of a potent opioid antagonist just doesn't sit well with me. I feel like this isn't entirely a rational fear on my part, I mean if I had ovaries I doubt I'd be so against some kind of IUD or hormonal implant (well, actually that probably wouldn't sit well with me either)... Iono, to each one's own.

As long as someone goes into it with all the information before them and isn't being played by any of the party's involved (whether family, treatment providers, friends or Pharma companies), I'm all for having more options to aid us in our various journeys of recovery. Even if I wouldn't choose a particular path, I can respect it has gotten others to the same place I'm working towards.
 
Well this took me back to an interesting place. PWD from Naltrexone is no joke. I get a sick feeling just remembering it.

Good luck libertine, it sounds like you made it out of the hellhole phase and into normal WDs. Stay strong mate and keep us posted.
 
Bad idea. If you get high before you'll most likely get sick as shit when the Vivitrol starts antagonizing opiate receptors and after, the amount of drugs needed to override the Vivitrol is dangerous. If you want to keep getting high just don't take the shot.
 
I strongly agree with aihfl. Bad idea all around.
 
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