I work at a convenience store as a clerk. Consequently, I meet a lot of different people from different walks of life.
I have one customer in particular, who I have mentioned TSM/Naltrexone to, in regards to my own use. This customer is a former drug addict, now trying to come off of methadone. I read briefly in Dr. Eskapa's book about TSM/Nal for heroin/methadone addiction, but I am not entirely clear if it is a suitable treatment for addiction to methadone.

Can anyone shed any light on the subject for me? I would like to reccomend TSM to this customer, but I'm not sure if it is a viable option for methadone treatment. Your thoughts are greatly appreciated. Thanks.

WAX

one cannot mix narcotics with naltrexone. they would go into an instant detox. however i am not sure if methadone works as a narcotic? also, i know naltrexone is used to help heroine addicts.

Boy this is tricky. Why not post a question to Dr. Eskapa? And please don't recommend this to anyone. You might, instead, loan out your copy of the book and let people make their own decisions.

Or recommend this site to them? Be careful even though I know in your heart you want to help.

Could I shine a little light in here naltrexone was originally developed as a treatment for opiate (narcotics) addiction, ie heroin, morphine, methadone, but because of the way it works, I would say, professionally, that TSM would not work in narcotic addiction. TSM works by extinction of the urge to drink, ie you have to be drinking to use the method, and this urge is gradually extinguished - as it has with me. But if someone was using methadone and tried extinction, then they would feel very unwell very quickly. Originally naltrexone was given to addicts after they had detoxed and were free of opiates, indeed, the manufacturers state that a challenge dose of naloxone, a shorter acting form of naltrexone should be given before starting the naltrexone treatment, to see that all opiates are gone from the body. The function of the naltrexone is to block the opiate receptors so that any opiate has no effect. I suppose that there is an element of psychology here, in that if an addict sees that the heroin is no longer working, then they are less likely to take any more. However, the manufacturer also cautions that any attempt to overcome the naltrexone block can be fatal.

I have been taking naltrexone for a month or so, and already I can feel the difference - no longer does one drink lead to another adinfinitum, I don't crave alcohol as once I did. I can drink if I choose, and even then if I drink, it's no more than 500ml a day of 5% alcohol (lager). I have been following Sinclair and the use of naltrexone in alcohol disorder ever since he published his first paper, and I am glad to see that it is helping so many people.
regards
darfieldboy UK

Indeed, naltrexone in opioid users can be dangerous. For example this note:

Singh SM, Sharma B. PSYCHIATRIA DANUBINA, 2009, 21(1):65-67
Abstract: Background: Naltrexone is a competitive opioid antagonist and is often used to maintain abstinence in detoxified opioid dependent patients. However, it can precipitate all accelerated withdrawal when ingested by all individual with concurrent opioid use.
Methods: We report the case of a 28 year old male with opioid dependence syndrome, presenting with chaotic symptoms following ingestion of naltrexone. Symptomatology, management is described and literature in this area is reviewed.
Results: Accidental or surreptitious ingestion of nultrexone in a patient with concurrent opioid use can precipitate symptoms typical of opioid withdrawal in addition to other varying symptomatology. Most cases would require sedation and management of concurrent vomiting and diarrhoea.
Conclusions: Clinicians, especially those providing substance abuse and emergency care, need to he aware of the possibility of an accelerated and possibly life threatening withdrawal associated with naltrexone ingestion in all incompletely detoxified patient with opioid dependence.

Same thing:

Quigley MA, Boyce SH. EMERGENCY MEDICINE JOURNAL, 2001, 18(6):494-495.
Abstract: Naltrexone is a long acting opioid antagonist that is used in rehabilitation programmes to maintain heroin abstinence. It is a relatively new drug prescribed by specialists in substance misuse. Its actions and effects may not be familiar to many accident and emergency doctors or even to the people who take it. A case report is described where accidental ingestion of naltrexone results in a medical emergency by precipitating acute withdrawal in a heroin addict.