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\u2009days, 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\u2009days 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\u2009U.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.