the facts about
 

NALTREXONE
 

for Treatment of Opioid Addiction 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Treatment 

www.samhsa.gov 
“It’s not like I woke up one day when I was

young and told myself, ‘I wanna be a drug

addict. I wanna ruin my life and ruin the

lives of those around me.’ I’ve learned now 

that this is a disease, and when I pick up

that first drug, I can’t stop.” 

Dan P. 

How do you return from the ruin of drug addiction? Most 

people cannot do it alone. They need help to return to normal, 

healthy living. One important form of help is called medicationassisted treatment. 

There are three, equally important parts to this form of 

treatment: 

•	Medication 

•	Counseling 

•	Support from family and friends. 

Naltrexone is one type of medication used for treatment 

of opioid addiction. Perhaps your doctor or substance abuse 

treatment provider has recommended it for you, or perhaps 

you already take it. This booklet gives you the facts you need 

to know. 

NOTE: Important words often used in treatment are 

introduced in this booklet in bold type. 

ii 
Opioid addiction is a disease. 

Opioids are drugs that slow down the actions of the body, such as 

breathing and heartbeat. Opioids also affect the brain to increase 

pleasant feelings. They get their name from opium, a drug made 

from the poppy plant. 

Opioid medications are prescribed to treat pain and sometimes 

for other health problems such as severe coughing. Heroin is an 

illegal opioid that is smoked, snorted, or injected to get a good 

feeling, often called a “rush” or “high.” People also sometimes 

seek this feeling by taking large doses of prescription opioids. 

If you take opioids, you can become tolerant to them. This 

means that more of the drug is needed to obtain its effects. It 

is also possible to become dependent on opioids. This means 

that if you stop taking them, you will feel sick. This sickness is 

called withdrawal. Dependence is not the same as addiction, 

but sometimes dependence leads to addiction. The signs of 

addiction are: 

	 	

•	Craving—The mind develops an overwhelming desire for 

the drug. 

•	Loss of control—It becomes harder to say no to using the 

drug. Use is compulsive and continues even though the drug 

causes harm. 

Tolerance and dependence are common side effects of 

prescribed opioid medication that can be managed under a 

doctor’s care. Tolerance and dependence also are side effects 

from misuse of opioids. Addiction is not likely to develop in a 

person using medication properly, but this sometimes happens. 

Addiction usually occurs through misuse. Some people are at 

higher risk of addiction because of their genes, temperament, 

or personal situation. 

1 

1
Not everyone who uses opioids gets addicted. But it is difficult to 

stop using opioids after you have become addicted, because the 

cravings are so strong and the fear of withdrawal is so great. 

Opioid addiction can be treated. 

Opioid addiction is a chronic disease, like heart disease or 

diabetes. A chronic disease is a medical condition for life. It can

not be cured, but it can be managed. A person with addiction 

can regain a healthy, productive life. 

But if you are like most people, you cannot walk away from 

addiction on your own. Treatment—the care of medical pro

fessionals and substance abuse treatment providers—can help. 

Treatment helps you give up the problem drug. It helps you get 

through withdrawal and cope with cravings. Treatment also 

helps you change addictive thinking into nonaddictive, health

ful patterns. It can help you move away from other harmful 

behaviors, too, such as drinking alcohol or abusing other drugs 

besides the problem opioid. 

Just as important, treatment helps you address life issues you 

might have that are tied to the addiction, such as feelings of 

low self-worth, a bad situation at work or home, or spending 

time with people who use drugs. In short, treatment helps you 

move into a healthy, addiction-free lifestyle—into a way of living 

referred to as recovery. 

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2 
Treatment may include medication. 

Medication-assisted treatment is treatment for addiction 

that includes the use of medication along with counseling and 

other support. Treatment that includes medication is often the 

best choice for opioid addiction. 

If you are addicted, medication allows you to regain a normal 

state of mind, free of drug-induced highs and lows. It frees you 

from thinking all the time about the drug. It can reduce prob

lems of withdrawal and craving. These changes can give you the 

chance you need to focus on the lifestyle changes that lead back 

to healthy living. 

Taking medication for opioid addiction is like taking medication to 

control heart disease or diabetes. It is NOT the same as substi

tuting one addictive drug for another. Used properly, the medica

tion does NOT create a new addiction. It helps you manage your 

addiction so that the benefits of recovery can be maintained. 

Naltrexone is a medication used to 

treat opioid addiction. 

Naltrexone is one of three medications commonly used to treat 

opioid addiction. The other two are methadone and buprenor

phine. Cost varies for the different medications. You may need to 

take this into account when considering your treatment options. 

Naltrexone blocks opioids from acting on the brain, so it takes 

away the reward of getting high on the problem drug. This 

feature makes naltrexone a good choice for preventing relapse

(falling back into problem drug use). 

Naltrexone may not stop drug cravings. If it does not help with 

cravings, your doctor or substance abuse treatment provider 

will help you find other ways to reduce them. 

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3 
Naltrexone may be prescribed if it is 

the right choice for you. 

Before you are given the first dose of any medication for opioid 

addiction, your doctor will ask you questions about your addic

tion, health, and other problems. You will get a drug test—usually 

a check of urine or saliva. You also will have a physical exam and 

tests for diseases that are common to people who have been 

abusing drugs. Your liver will be checked to make sure the medi

cation can be safely taken. If naltrexone is safe and appropriate 

for you, your doctor may recommend it. 

Naltrexone comes in pill form. Two trade names for it are 

ReVia® and Depade®. It is also available as a lower cost generic. 

You take the pill every 1 to 3 days. 

Naltrexone may be a good choice if you are completely past 

withdrawal and highly motivated to stay in recovery. It also may 

be recommended if you are in an early stage of opioid addiction. 

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You and your doctor or substance abuse treatment provider 

decide together on a treatment plan. The plan describes the 

medication routine, the counseling and other services that will 

be provided, and the rules that must be followed. These rules 

will be explained to you, and you will get them in writing. 

44 
Naltrexone must be used carefully. 

You must have no opioids in your body before starting naltrex

one. Otherwise, withdrawal will be extra strong. You first must 

go through withdrawal under your doctor’s care. This supervised 

withdrawal is called detoxification or detox. You can start on 

naltrexone 7 to 10 days after detox is completed. 

Your doctor will first prescribe a low dose. Your dose levels 

may be adjusted up as needed. Always take doses exactly as 

prescribed by your doctor. 

You may take naltrexone for days, months, or years—as long 

as it is needed to prevent relapse. However, you should be 

checked often by your doctor if you have liver disease. 

Naltrexone does not cause withdrawal when you stop taking it. 

Naltrexone has side effects in some 

people. 

Side effects are feelings of discomfort or sickness that come 

with taking medicine. Naltrexone has a few mild side effects. 

Usually these go away after the medicine is taken for a while.
 

­

If you are stable in recovery and want to stop taking naltrexone, 

you do not need to taper off over time. However, you should 

always consult with your doctor before quitting naltrexone. 

Some people who take naltrexone carry a medical card in case 

they need emergency care. The card explains that they cannot receive medications containing opioids and they will need 

special care if they are in pain. Ask your doctor whether you 

should carry a card. 

5
 

 

If you have side effects, you should NOT stop taking the 

medication. Instead, talk with your doctor or substance abuse 

treatment provider. An adjustment in dosage or a change in 

medication might help. There are some simple things you can 

do to reduce side effects, too. 

WaRNiNgs

•	If you are taking naltrexone, you cannot get high from 

other opioids because the medication blocks the effects. 

Sometimes people take large amounts of opioids to try 

to overcome this block. Do NOT do this! It is VERY 

dangerous and can cause overdose or death. 

•	Naltrexone kept at home must be locked in a safe place 

to prevent accidental use by others, especially children. 

•	If you are a woman and are pregnant or breast-feeding, 

you should NOT take naltrexone. Methadone is safer for 

mother and child. 

•	Liver problems are rare but can occur. If you have a preexisting liver condition, your doctor should conduct regular 

tests on your liver. 

•	While taking this medication, you should NOT use other 

opioid medications such as some pain medications, cough 

syrups, and diarrhea medicines. The naltrexone will stop 

these medications from working. You should let doctors and 

dentists know you cannot have any medications (including 

shots) that contain opioids. 

•	While taking this medication, you should NOT use illegal 

drugs, drink alcohol, or take sedatives, tranquilizers, or 

other drugs that slow breathing. Taking any of these 

substances in large amounts along with naltrexone can 

lead to overdose or death. 

6 
7 

CoMMon SiDe	effeCtS

anD	SiMpLe WayS	to ReDuCe	theM 

upset stomach or vomiting—Take the pill with food or 

after a meal. Take an antacid product as directed by 

your doctor. 

Diarrhea—Drink plenty of water or juice. Also, ask your 

doctor to recommend an over-the-counter medicine. 

headache—Use over-the-counter headache medicines ac

cording to package instructions. 

Nervousness—Take a walk, take a hot bath, or take deep 

breaths. If this problem is serious or lasts a long time, 

tell your doctor or substance abuse treatment provider. 

Sleep problems including tiredness—Take the pill in the 

morning. Avoid naps. Go to bed at the same time every 

night. Exercise. Do not drink caffeine after lunchtime. 

Joint or muscle pain—Use over-the-counter pain medi

cines according to package instructions. 

Serious side effects—For extreme stomach pain, vomiting, 

or diarrhea, contact your doctor right away. Also seek 

help if the following side effects appear, because they 

may indicate serious liver problems: 

•	Dark or tea-colored urine

•	Bad stomachache

•	Light-colored bowel movements

•	Yellowing in the whites of the eyes 

•	Yellow skin. 

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Counseling can help. 

Medication is one part of treatment for opioid addiction. 

For many people, another important part is counseling: the 

opportunity to talk with a professional either one-on-one or in 

a group with others in treatment.
 

Through counseling, you learn about the motivations and be

haviors that led to your opioid addiction. You learn to commit 

to a more healthful lifestyle. You gain support and skills while 

working with others to manage your recovery long term. 

Counseling can provide encouragement and motivation to 

stick to treatment. It can help you learn how to make healthy 

decisions, handle setbacks and stress, and move forward with 

your life.
 

In group counseling, you connect with others in treatment 

and make new friends who don’t use drugs. You can get these 

benefits from support groups, too. These are informal meet

ings of people facing similar challenges.
 

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88 
Family and friends are important, too. 

It is very hard to go through recovery alone. Support from fam

ily and friends is very important. Love and encouragement can 

help you make the decision to enter treatment and stick with it. 

Some treatment programs offer counseling for your loved ones. 

They do this because your addiction may have caused pain and 

anger or feelings of shame and hopelessness. 

Counseling is a useful way for family and friends to learn more 

about your situation, how to help, and how to handle the prob

lems your addiction has caused them. It is a safe place for them 

to express feelings and to find out what help is available for 

everyone affected. 

There are support groups for families and friends, too. These 

are safe places to share information and encourage others who 

have loved ones who are dealing with addiction. 

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Many people with opioid addiction regain normal, healthy lives. 

One way they do this is with medication-assisted treatment. 

Medication, counseling, and support: together they can help 

you, your loved ones, and your friends. 

“For me, being in recovery is about having

a job. It’s about being an active member of

my family. It’s about having friends. It’s

about having a social network. It’s about

having passion in my life again.” 

Tom C. 

9 

9
		

	 	 	

	 	 	 	 	 		

	 	 	

	 	 	 	 	

	 	 	 	 	 	

	 	 	 	 	 	 	

	 	

acts 	 f h e

t

aDDiCtion

What’S	tRue anD	What’S	not

addiction is a disease. It cannot be cured, but it can 

be treated with medication, counseling, and support 

from family and friends. Addiction is NOT a sign of 

weakness. It is NOT TRUE that all you need to kick 

addiction is to “be strong.” 

the goal of medication-assisted treatment is

to recover from addiction. It does NOT replace 

one addictive drug with another. It provides a safe, 

controlled level of medication to overcome the use 

of a problem opioid. 

a	substance abuse treatment provider must

obtain your informed consent (a written agreement) before sharing information about you with

others. There are two exceptions to this privacy rule: 

(1) if it appears that you may harm yourself or others 

and (2) if you have been ordered into treatment by the 

courts. To learn more about your privacy rights, talk to 

your substance abuse treatment provider. 

Recovery is possible. But it takes work. After treatment is finished, everything is NOT automatically fine 

again. Recovery takes commitment every day, through 

treatment and beyond. 

10 
		

	 	 	 	 	

	 	 	 	 	 	

	 	 	

	 	 	 	 	 	 	 	

	 	 	 	

	 	 	 	 	 	 	

naLtRexone

What’S	tRue anD	What’S	not

naltrexone helps you avoid relapse. It is legal 

and taken under a doctor’s care. It is NOT just 

another drug to abuse. 

naltrexone is produced under safe conditions

and sold legally. There is no risk of getting tainted 

doses, which can happen with street drugs. 

you can stop taking naltrexone at any time

with no withdrawal or craving. It is NOT 

addictive. 

few people have mood swings when taking

naltrexone. It does NOT cause depression. If you 

have symptoms of depression, talk to your doctor— 

there may be some other cause. 

the 	 f acts

11 
	 	

Support groups and information 

•	This is not a complete list. Listing here does not mean that 

the Substance Abuse and Mental Health Services Administra

tion (SAMHSA) endorses any of the organizations. 

­

•	Some support groups have abstinence-only policies and do 

not look favorably on medication-assisted treatment. The 

programs listed here do not have such policies, but individual 

group meetings vary. You may need to try several support 

groups to find the right one. 

•	Some support programs are just for people with a substance 

use disorder, and others allow families and friends to attend 

meetings or have separate meetings for them. Check with 

each organization for details. 

•	An Internet-based support group may be your best option 

if no groups meet in your community. Another option is to 

contact Alcoholics Anonymous (AA, http://www.aa.org) to 

find out whether AA meetings in your community are open 

to people in recovery from other substances besides alcohol. 

Dual Recovery anonymous

http://www.draonline.org or 913-991-2702 

LifeRing

http://www.unhooked.com or 800-811-4142 

narcotics anonymous

http://www.na.org or 818-773-9999 

Rational Recovery

http://www.rational.org or 530-621-4374 

Secular organizations for Sobriety

http://www.cfiwest.org/sos/index.htm or 323-666-4295 

1212 
	 	

Substance abuse treatment facility 

locator 

SMaRt	Recovery

http://www.smartrecovery.org or 866-951-5357 

Women for Sobriety,	inc.

http://www.womenforsobriety.org or 215-536-8026 

800-662-HELP (4357) (English and Español) 

800-487-4889 TDD (for hearing impaired) 

http://dasis3.samhsa.gov 

Free booklets 

•	The Facts About Buprenorphine for Treatment of Opioid 

Addiction (SMA) 09-4442 (also in Spanish) 

•	Medication-Assisted Treatment for Opioid Addiction: Facts 

for Families and Friends (SMA) 09-4443 (also in Spanish) 

•	Introduction to Methadone (SMA) 06-4123 

•	Faces of Change: An Illustrated Booklet for Consumers 

(SMA) 08-4174 

•	What Is Substance Abuse Treatment? A Booklet for Families 

(SMA) 08-4126 (also in Spanish: (SMA) 08-4098) 

•	Motivación para el Cambio (Spanish only) PHD1133 

How to get free copies 

1. Ask your substance abuse treatment provider. 

2. Contact SAMHSA’s Health Information Network (SHIN) at 

877-SAMHSA-7 (877-726-4727) (English and Español). 

3. Order from SHIN’s Web site at http://www.samhsa.gov/shin. 

4. Download the products from http://www.kap.samhsa.gov. 

13 
“You know, there’s a saying in recovery 

communities about promises and promises 

being true. And don’t quit until the miracle 

happens. And that sounds very esoteric 

and wonderful and feel-good. But it 

actually is true.... Recovery and sobriety 

let me show up for life today.”— 

 Tim S. 

aCknoWLeDgMentS

This booklet was produced by JBS International, Inc., under Contract No. 270-04-7049 

with the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental 

Health Services Administration (SAMHSA), U.S. Department of Health and Human 

Services (HHS). 

All material appearing in this booklet is in the public domain and may be reproduced 

or copied without permission from SAMHSA. Citation of the source is appreciated. 

However, this publication may not be reproduced or distributed for a fee without 

specific, written authorization of the Office of Communications, SAMHSA, HHS. 

This publication may be downloaded or ordered at http://www.samhsa.gov/shin. Or, 

please call SAMHSA’s Health Information Network at 877-SAMHSA-7 (877-726-4727) 

(English and Español).

HHS Publication No. (SMA) 09-4444 

Printed 2009