There seems to be a little confusion about the difference between the two “nal-xone” drugs, naltrexone and naloxone. Two very different drugs, the similar names are confusing but what makes it worse is the fact that both are related to the treatment of drug and alcohol abuse. Hopefully this will clear up the misconceptions.

Naltrexone

Naltrexone, like naloxone, is an antagonist that binds to opioid receptors and blocks the effects of opiates. However, naltrexone is used primarily in the treatment of alcohol addiction in an effort to reduce the craving to drink. Its generic name is naltrexone hydrochloride, but it’s sold under the brand names Revia and Depade. An extended release formula is also sold as Vivitrol.

After detox off of opiates or alcohol, naltrexone may be prescribed to help people stay off the sauce—in any form. It effectively blocks any opiates from binding to your opiate receptors so if you do try to get loaded while you’re taking it, it won’t work. You won’t get high at all. But for some reason, it’s rarely prescribed to people who suffer solely from opiate dependence but rather to those who need help fighting the urge to drink. With studies to back it up, it works well to prevent relapse and decrease the severity of relapse when it does occur. For those who need help with opiate addiction, a better medication is Suboxone, which combines buprenorphine and naloxone.

Naloxone

Sold under the brand name Narcan, naloxone is injected into a muscle when overdose on an opioid-based drug occurs. Whether you overdose on a prescription painkiller like Fentanyl, Vicodin, Dilaudid, Darvon or Darvocet, Norco or OxyContin or you overdose on a street drug like heroin or morphine, naloxone stops the overdose dead in its tracks (no pun intended).  It works by heading straight to the opiate receptors and knocking off any opiates that are there, which stops the respiratory depression they cause and the subsequent overdose. It doesn’t work for benzodiazepines like Valium, Xanax, Valium, or Klonopin, nor does it work for stimulants like methamphetamine and cocaine.

Naloxone stays active in the system, blocking opiates from binding to your opiate receptors for 30 minutes to 90 minutes. When it wears off, the opiates that caused the overdose are still in your system and their effects will kick in again and, possibly, slam you right back into an overdose. This brief reprieve, however, can be what you need to keep you from dying before you get emergency medical help.

A few things you should know:

- Naloxone won’t let you give a clean drug test.
- Naloxone is effective in fighting an overdose even if you hit a vein.
- Naloxone is ONLY meant to be delivered with a needle in the event that someone is dying.

Suboxone

If you are addicted to opiates and taking Suboxone to detox off of your drug of choice, then you are taking naloxone. Suboxone is a combination of buprenorphine and naloxone, and it comes in a pill that you take by dissolving it beneath your tongue. The naloxone remains dormant unless you should try to abuse the Suboxone by dissolving it in water and inject it. If you do this, the naloxone will kick in and prevent you from experiencing any of the relief that the buprenorphine provides for those trying to avoid withdrawal symptoms.

So hopefully that clears that up! Any questions?

Hepatitis C is truly a global issue and a group of scientists in Adelaide, Australia, have started a five-year project to find better treatment options and to create vaccines to fight the disease. More than 170 million around the world are infected with hepatitis C, and University of Adelaide virologists Dr. Michael Beard and Dr. Karla Helbig are putting themselves on the battlefield’s front lines and trying to identify antiviral proteins that will stifle the disease.

No effective vaccine exists right now and the interferon treatment currently used is basically a form of chemo and debilitating in itself. It also doesn’t work on all strands of hepatitis C or necessarily work the first time you take it. Its success rate is only between 50 percent and 80 percent. Hopefully this new project will give birth to better treatments and an effective vaccine.

Dr. Beard is an NHMRC RD Wright Research Fellow and head of the Hepatitis C Virus Research Group at the University of Adelaide and Institute of Medical and Veterinary Science. He says that this is the first time that anyone in Australia has studied both HIV-AIDS and hepatitis C: “The development of vaccines and better treatments for both these viruses are urgent global health priorities. This program brings together a team of researchers with skills in basic virology and immunology with experts who can translate laboratory findings into human clinical trials.

“In Australia, more than 264,000 people have been infected with the hepatitis C virus and there are approximately 10,000 new infections per year. A proportion of these are intravenous drug users.”

Until a better treatment and vaccine are developed, IDUs can practice harm reduction by changing their method of use. Rather than using needles to shoot heroin, they can choose a maintenance program or take an even greater step and detox off of heroin using Suboxone. With Suboxone treatment, you can be off needles immediately and off drugs entirely in as few as six weeks depending upon your situation. Get more information about Suboxone here.

For more information about this project, check out the University of Adelaide website.

A hot debate happening in medical circles these days is this: should they give heroin to heroin addicts who are difficult to treat? The British Medical Journal (BMJ) offers arguments on both of sides of the fence.

On the “yes,” side there’s Jurgen Rehm from the Centre for Addiction and Mental Health in Toronto and Benedikt Fischer from the University of Victoria in British Columbia. Their argument that different circumstances call for different measures and that in some cases, heroin may be an appropriate treatment for heroin addicts. The idea is that it’s cost-effective compared to methadone maintenance and has been carried out with positive results in different parts of Western Europe with addicts who were resistant to treatment. Apparently, it’s an option in the UK but the practice is hotly debated.

On the “no” side is Neil McKeganey, a Professor of Drug Misuse Research at the University of Glasgow. He says that the evidence for the efficacy of the treatment are inconclusive and that the mortality of addicts on the treatment as compared to other programs is low. He feels that treatment programs should strive to diminish an addict’s use of heroin rather than just help them maintain a regular habit. It goes beyond harm reduction, or should, in his opinion.

I’m not usually one to take the conservative view, but in cases like these, but in this situation, I find myself solidly on the “no” side. Not necessarily for the reasons put forth by BMJ’s columnist but more for the fact that you still have to cook it, you still have to inject it. It’s feeding both the physical addiction and the mental addiction and, to me, that’s not much of a treatment, even if it does reduce the harm of buying drugs on the street and possibly overdosing.

For more on both sides of the argument, check out “Should heroin be prescribed to heroin misusers? Yes” by Jürgen Rehm, Benedikt Fischer and “Should heroin be prescribed to heroin misusers? No” by Neil McKeganey.