12
Treatment
Î Buprenorphine taper and discontinuation is a slow process; close
monitoring is recommended.
• Buprenorphine tapering is generally accomplished over several months. Patients
should be encouraged to remain in treatment for ongoing monitoring past the
point of discontinuation.
Naltrexone
Î MAJOR REVISION – Extended-release injectable naltrexone is a
recommended treatment for preventing relapse to OUD in patients
who are no longer physically dependent on opioids, able to give
informed consent, and have no contraindications to this treatment.
Î MAJOR REVISION – Extended-release injectable naltrexone should
generally be administered every 4 weeks by deep IM injection in the
gluteal muscle at the set dosage of 380mg per injection.
Î MAJOR REVISION – Oral naltrexone is NOT recommended except
under limited circumstances (see p. 7 for more details).
Î Patients' psychosocial needs should be assessed, and patients should
be offered or referred to psychosocial treatment based on their
individual needs, in conjunction with extended-release naltrexone.
• A patient's decision to decline psychosocial treatment or the absence of available
psychosocial treatment should not preclude or delay naltrexone treatment, with
appropriate medication management.
• Motivational interviewing or enhancement can be used to encourage patients
to engage in psychosocial treatment services appropriate for addressing their
individual needs.
Î There is no recommended length of treatment with naltrexone.
• Duration depends on clinical judgment and the patient's individual circumstances.
• Because there is no physical dependence associated with naltrexone, it can be
stopped abruptly without withdrawal symptoms.
Î Transitioning from naltrexone to methadone or buprenorphine should
be planned, considered, and monitored.
• Transitioning from an antagonist such as naltrexone to a full agonist (methadone)
or a partial agonist (buprenorphine) is generally less complicated than
transitioning from a full or partial agonist to an antagonist because there is no
physical dependence associated with antagonist treatment and thus no possibility
of precipitated withdrawal.
• Patients being transitioned from naltrexone to buprenorphine or methadone will
not have physical dependence on opioids, and thus the initial doses of methadone
or buprenorphine should be low.
• Patients should not be transitioned until a significant amount of the naltrexone is
no longer in their system, about 1 day for oral naltrexone or 28 days for extended-
release injectable naltrexone.
