Dr. Eskapa,

I regulary see a psychiatric nurse practitioner who says she is supportive of TSM, however, she told me she is "not allowed" to write a prescription for Naltrexone. She writes prescriptions for antidepressants and has asked whether I would like one for Campral (I declined), but she said there are special certification classes medical professionals must take in order to get clearance for Naltrexone. As a result, I have been ordering mine online but it's getting very expensive.

Do you know of any reason why a nurse practitioner would be prohibited from dispensing Naltrexone?

Thank you.

While waiting for Eskapa to reply, I thought I'd share the following resources you can share with your nurse practitioner if you'd like.

Your nurse practitioner is wrong. I believe she is confusing naltrexone with suboxone -- a drug with vaguely similar properties used to treat opiate addiction. Special certification is required to prescribe suboxone. Not so of naltrexone. She easily can verify this.

The Project COMBINE study http://jama.ama-assn.org/cgi/content/ab ... 95/17/2003 -- the largest study ever done of alcoholism treatment -- showed naltrexone to be the most effective treatment with only basic medical management, not combined with any psychological counseling. This is the main reason so many family physicians (not addiction specialists) are willing to prescribe naltrexone for those on this board who choose to work with their doctor.

Here is a New York Times article by Jane Brody that several people here have brought to their doctor:
http://query.nytimes.com/gst/fullpage.h ... one&st=cse

Here is a link to reprints of chapters from Eskapa's book; the one titled "For Medical Professionals" has been persuasive with the doctors of people here who printed it and brought it to the doctor. You may want to do that, or direct your nurse practitioner to the link.
viewtopic.php?f=3&t=6

If the expense of online ordering is your chief concern, you may want to consider the long-term risk/cost of having this in your medical history. Many of us order online for just that reason. Here's the experience of one member on this board:
viewtopic.php?f=7&t=1617&p=19616&sid=94b3a9bb09a7ed6fab215e043b06eaf4#p19616

Hope this helps.
Edited to include omitted link!

Lena,

Thank you. This information is invaluable and I intend to bring it all along to my appointment next week.

With regard to my medical records, I have already recently applied for and been denied life insurance for reasons of "substance abuse." Despite my attempt to avoid the stigma by buying Naltrexone online, my doctor has labeled me a substance abuser based only on conversations we've had wherein I was asking for help with my drinking. (Incidentally, I have never abused drugs other than alcohol.)

Of course I feel victimized; I'm a single mother of two young children, but what can I do about it? If the die has already been cast, the least they can do is help me obtain my prescription at a reduced price. Or do you think that will only further serve to damage my medical reputation?

Thank you again so much for all your help!