Drug Safety

, Volume 41, Issue 10, pp 979–980 | Cite as

Potential Risk Window for Opioid Overdose Related to Treatment with Extended-Release Injectable Naltrexone

  • Ingrid A. BinswangerEmail author
  • Jason M. Glanz

Extended-release (ER) injectable naltrexone (Vivitrol®) is a monthly injection approved for the treatment of opioid use disorder in the US. Other treatments for opioid use disorder include opioid agonists or partial agonists such as methadone and buprenorphine-containing products (e.g. buprenorphine-naloxone). As an opioid antagonist, naltrexone blocks the euphoric effects of opioids and may reduce the risk of opioid overdose once individuals are successfully induced into treatment [1]. However, paradoxically, the risk of opioid overdose may increase if individuals try to challenge the opioid blockade associated with naltrexone [2]. Two recent studies raise concerns about the susceptibility to opioid overdose associated with ER injectable naltrexone. In a randomized trial (n =570) comparing the effectiveness of buprenorphine-naloxone with ER injectable naltrexone, 15 individuals had 18 overdose events in the ER injectable naltrexone arm, compared with 8 individuals who had 10 overdose...


Compliance with Ethical Standards


Drs. Binswanger and Glanz are supported by the National Institute on Drug Abuse of the National Institutes of Health under award number R01DA042059. The National Institutes of Health did not contribute to the conception or writing of this commentary, or the decision to submit this article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflicts of interest

Ingrid A. Binswanger is employed by the Colorado Permanente Medical Group and receives royalties from Uptodate. Jason M. Glanz has no conflicts of interest that are directly relevant to the content of this commentary.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Institute for Health Research, Kaiser Permanente ColoradoDenverUSA
  2. 2.Colorado Permanente Medical GroupAuroraUSA
  3. 3.Division of General Internal MedicineUniversity of Colorado School of MedicineAuroraUSA
  4. 4.Colorado School of Public HealthAuroraUSA

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