Case report: Increasing the frequency of intramuscular naltrexone administration in a high risk patient with opioid use disorder

Abstract

Background: As the United States faces a national opioid crisis, opioid overdose deaths have significantly risen over the past decade. Patients with opioid use disorder, particularly those who use high-potency synthetic opioids, are at an increased risk of fatal opioid overdose. Alternative dosing strategies for the treatment of opioid use disorder must be considered in high-risk patients to prevent opioid overdose. Case: One patient with opioid use disorder at high risk for overdose was treated with extended-release (XR) intramuscular (IM) naltrexone initially every 28 days, but was frequently reporting increased cravings during the week prior to the next injection being due. This patient’s dose of XR IM naltrexone was then given at an increased dosing frequency of every 21–24 days for three months. Opioid craving suppression was achieved without clinical or laboratory evidence of side effects or hepatotoxicity. Discussion: In patients with especially high risk of opioid overdose, consideration of novel dosing strategies for continuation of opioid abstinence is necessary. This is the first report demonstrating the short-term safety and efficacy of more frequent dosing of XR IM naltrexone. This case demonstrates that in select high-risk patients, more frequent dosing of XR IM naltrexone may be an effective strategy to reduce opioid cravings. Informed Consent: The case was reviewed with the Intuition’s Privacy Officer who informed the authors that informed consent could not be obtained by the patient’s family members due to 38 U.S.C 7332 restrictions on protected information. This manuscript was de-identified and approved by the institution’s local privacy officer for publication in accordance with institution policy.

Keywords:

• Naltrexone
• opioid-related disorders
• drug overdose
• substance abuse
• intravenous
• substance abuse
• oral
• narcotic-related disorders
• medication assisted treatment of opioid
• opioid epidemic

Acknowledgments

The authors report no acknowledgements. The authors have no funding to report associated with this work.

Disclosure statement

No conflict of interest was reported by the author(s). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or any of its academic affiliates.

Author contributions

All authors, MW, JD, and TB, made substantial contributions to the conception of this work and the preparation of the manuscript. All authors, MW, JD, and TB, provided critical feedback in the revision of this work and approved the final manuscript.