Naltrexone, also known by its brand name, Vivitrol, is an opioid antagonist that kicks opioids off of opioid receptor in the brain, not unlike naloxone. But thanks to a combination of overprescription, unscrupulous marketing practices and ubiquitous use over more effective alternatives, naltrexone is a very controversial drug. In fact, a common reaction is Oh no! Not naltrexone!
Of course, naltrexone has some benefits and many people say their life has been saved by it. And at Narcotica, we don’t believe any drug is “bad” or “evil.” So where does this substance fit into the broader scheme of things? We’ve spoken about naltrexone many times on this show, but never this indepth before.
Narcotica co-hosts Zachary Siegel and Troy Farah speak with Nancy Curran, a nurse practitioner who has been practicing for 5 years in an OBOT clinic in the Lowell Massachusetts area, treating both opioid and alcohol use disorders. She prescribes buprenorphine (both Suboxone and Sublocade), as well as naltrexone (Vivitrol). She also treats patients who need Hep C treatment. Nancy is passionate about advocating for and educating her patients on their medication options, as well as their rights.
They discuss the history of hallucinogenic opioids, the shrewd and quasilegal marketing practices of Alkermes, Inc., how naltrexone stacks up against buprenorphine and methadone, why stigma persists against people who take certain opioid use disorder drugs but not others, the difference between addiction and dependency, some basic opioid receptor science, and much, much more.
Follow Nancy on Twitter at: @cashboygo
More background on naltrexone and the XBOT Studay can be found here and here. We also recommend reading Walter Sneader’s book: Drug Discovery, A History and also Nancy Campbell’s book OD: The Politics of Overdose.
You can read Zach’s article on Four Good Days and more here: https://www.nytimes.com/2021/05/11/magazine/addiction-movies.html
If you liked this episode, here are others you might enjoy:
Episode 19: Debunking Bupe Diversion Myths with Molly Doernberg
Episode 30: Getting Wrecked with Dr. Kim Sue
Episode 36: Moral Hazards and Naloxone, A Toxicologist’s Perspective with Ryan Marino
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Producers: Christopher Moraff, Troy Farah, Zachary Siegel
Co-producer: Aaron Ferguson
Music: Glass Boy / Nomad1
Intro voice: Jenny Schaye
Image: edit: Troy Farah