In a double-blind, placebo controlled trial, opioid dependent patients receiving a combination of clonidine and naltrexone exhibited transient, slight withdrawal symptoms. Patients were discharged with no withdrawal symptoms. Naltrexone appears to be useful in preventing recidivism in opioid abusers. All treatment successes have required intensive counseling programs, but regardless of the type of counseling, the naltrexone treated groups do better. Opioid Overdose Patients with opioid overdose present clinically stuporous to comatose with pinpoint pupils and decreased respiratory rate.
Blood pressure remains normal until late decompensation leads to hypotension.
A lethal overdose of morphine in the non-tolerant individual is 120 mg. A prospective non randomized phase II trial of nalmefene in opioid overdoses gave 1-10 boluses of either 0.5 mg or 1.0 mg of nalmefene to such patients. No adverse events were attributed to the use of nalmefene. Advantages of nalmefene over naloxone include its longer duration of opioid antagonism. There is less risk of renarcotization if the patient signs out against medical advice shortly after regaining consciousness.