Home 2018-10-09T22:11:16+00:00

California Addiction

Medical Group

Advanced Treatment of Opioid & Alcohol Addiction

Learn More

Alcohol Abuse & the Opiate Epidemic

The #1 goal for recovering addicted patients is to decrease their relapse rate and therefore decrease the resulting death rates.

The most effective approach consists of:

  • Decrease Cravings & Attraction to Drugs

  • Provide Support and Psychological Infrastructures

  • Decrease triggers and Increase Environmental Changes

Naltrexone and Probuphine Implants

The effectiveness of Extended Release Naltrexone

  • Takes the Cravings Away

  • Extinguishes the Obsession of  focusing on your Next Fix

  • Reduce Relapse Rate and Maintain Sobriety through Decreased Cravings

Comparison of Naltrexone Delivery Systems

Naltrexone 
50 mg Tablets
Vivitrol
Intramuscular
Naltrexone Implant
Delivery Method Oral Intramuscular Injection Subcutaneous
Frequency of Administration Every day Every month Every 3 -6 months
Advantages Simple to administer Don’t have to think about it for 30 days; Non-cyclic relatively constant blood levels Don’t have to think about it for 90 – 180 days; Non-cyclic relatively constant blood levels; Gives patient a more reasonable time to form the mindset of not using by allowing psychological, social and behavioral modification treatment methods to be effective; Acts as an additional “insurance” not to use again.
Disadvantages Compliance major disadvantage: Must take daily so it is easy to start using again by just stop taking it for a few days. Painful injection at site of administration; 30 day effectiveness period is generally not enough time to form the mindset of not using; Although the active ingredient, Naltrexone, has been FDA approved since 1984, its delivery in the form of an implant has not. However, this extended release implant is compounded by a licensed pharmacy under strict quality control and sterilization standards. Requires outpatient surgery center implantation, however recovery is rapid typically uneventful.

An Evidence Based Approach to Treatment

The use of Compounded Naltrexone Implants was published in an AMA associated peer reviewed journal.

  • Demonstrated the efficacy of Naltrexone controlled extended release devices.

  • Compared the use of oral and intramuscular versus implanted Naltrxone.

  • Showed decreases in cravings & attraction to drugs.

Naltrexone implants significantly improved the rate of relapse and therefore lowered the death rates of these opiate dependent patients.

Naltrexone Implant

Naltrexone significantly improved the rate of relapse and therefore lowered the death rates of these opiate dependent patients with a confidence level of p< .01.

This study appeared in the AMA psychiatric literature network published in the Archives of General Psychiatry1. This was a double blinded, double dummy (cross-over) randomized controlled study recruiting over 300 patients. An additional earlier RCT was conducted and the results published with a p< .05 demonstrating the effectiveness of extended release Naltrexone2

1. Arch Gen Psychiatry, September 2012; 69(9): 973-981. Also see http://archpsyc.jamanetwork.com
2. British J of Psych (2009) 194, 541-546: 10.1192/bjp.bp.055319

Mode of Action

Naltrexone is an opiate antagonist binding to μ-opiate receptors. It was FDA approved for opiate addiction in 1984 and for alcohol in 1994. Vivitrol injections of extended release Naltrexone lasts about one month and was approved in 2006.

Although the active ingredient, Naltrexone, has been FDA approved since 1984, its delivery in the form of an implant has not. However, this extended release implant is compounded by a licensed pharmacy under strict quality control and sterilization standards and has been available for over 15 years. It typically remains in the subcutaneous tissue of the left or right abdominal quadrant for 3 – 6 months, then biodegrades and is dissolved. Depending on pellet design and the patient’s metabolism, Naltrexone blood levels remain therapeutic during this time period.

Comprehensive Medical Assessment

Internal Medicine Pre-op Exam includes detailed medical history of the opiate and/or alcohol abuse and dependency:

  • Physical Exam with particular emphasis on signs of substance abuse and pre-operative clearance

  • Psychiatric Examination to determine patient’s probable success as a result of this procedure

  • Resting 12 lead EKG with rhythm strip

  • Laboratory including related co-morbidities i.e. STDs, HepC etc and pre-op CBC c diff, metabolic screen, blood coagulation + Urine Toxicology screen for a minimum of 12 commonly abused substances

The Procedure

On the day of the implant the patient is admitted to a fully licensed and certified surgical outpatient center and again undergoes a witnessed urine toxicology screen.

Patient is prepared per standard protocol for a pre-surgical subcutaneous procedure. Intravenous anesthetic is administered and a small 1 to 1.5cm incision is made in order to insert the Naltrexone implant.  The implant is biodegradable and dissolves in 3 or 6 months depending on the compounding pharmacy that manufactured it.

Post surgical monitoring is done over the next 3-6 months and Includes immediate wound healing and urinary Naltrexone metabolite level

Patient Qualifications

The patient must have an extensive history of alcohol or opiate abuse with multiple attempts at treatment in licensed detox and recovery facilities resulting in relapses and failure. Must be clean, sober and stable for at least 30 days. Must have at least a 7-10 day prior exposure to Naltrexone in any form prior to entering this program.

Probuphine Implant

Appropriate Candidates for this treatment approach to the opiate addiction epidemic

This method is only appropriate for opiate (not alcohol addicted) patients who have been maintained on a low daily dose of sublingual Suboxone (buprenorphine) and have been stable for at least 60 days on a maximum dose of 4mg per day.

This implant, the procedure utilized to implant, and specific physician training requirements were FDA approved in 2016 while the active drug buprenorphine (a partial opiate agonist) was approved in 2002 for opiate detox.

We have cash discount and financing plans available.
We also accept all major credit cards and
select PPO insurance plans that accept out of network providers.