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Missing Link in the Opioid Prevention Strategy

HHS announced a prevention strategy incorporating elements of harm reduction like widespread distribution of naloxone and syringes. This is commendable but woefully inadequate and very unlikely to bring down opioid overdose deaths. As long fentanyl and similar analogs keep pouring in the present strategy will not work.

What is the missing link? It is the shocking failure not to look at naltrexone as a preventative medication. Naltrexone was developed by the federal government as a non-addicting drug to protect opioid detox patients from relapsing when they returned home from residential treatment or incarceration. It was approved by the FDA in 1984! Today for many ‘home’ is a swamp teeming with drugs – heroin, fentanyl, cocaine, meth. How can you expect a patient returning to the swamp not to relapse within hours and days?

Not too long ago, it was unthinkable to deploy naloxone, a medication very similar to naltrexone. It may come as a surprise to many that naloxone is not a new medication. It was approved by the FDA in 1971, no it is not an error. Naloxone sat on the shelves for decades and now is seen as a wonder drug and people are asking, why did we wait so long to deploy this amazing medication.

Naltrexone is closely related to naloxone. It is time we deploy this non-addicting medication as a preventative measure to protect high-risk patients from relapsing. This strategy is similar to using anti-retroviral medications to prevent HIV infections in high-risk patients. This preventative approach is called Pre-Exposure Prophylaxis (PrEP) and is widely accepted as an important strategy to prevent HIV infections.

PrEP for opioids takes harm reduction to a new level - harm avoidance. Why are we so reluctant to deploy naltrexone while the opioid epidemic is raging? Let’s not be caught asking the question again, why we waited so long to deploy this highly effective medication.

Percy Menzies, M. Pharm. is the president and founder of the Assisted Recovery Centers of America (ARCA), an integrated medical clinic based in St Louis. He can be reached at:


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