Name of the Procedure:

• Common Names: Injection of Naltrexone, Depot Form
• Technical/Medical Terms: Intramuscular Injection of Depot Naltrexone (HCPCS J2315)

Summary

This procedure involves an injection of depot naltrexone, a medication used to block the effects of opioids and reduce cravings for alcohol. The depot form ensures the medication is released slowly over time, providing a long-lasting effect.

Purpose

• Medical Conditions: Opioid dependence, Alcohol use disorder
• Goals/Outcomes: Prevents relapse in opioid or alcohol-dependent individuals by blocking the euphoric effects of opioids and decreasing the urge to consume alcohol.

Indications

• Symptoms/Conditions:
  • Patients diagnosed with opioid dependence or alcohol use disorder who seek to maintain abstinence.
• Patient Criteria:
  • Adults who have undergone detoxification from opioids or alcohol.
  • Patients who have not used opioids or alcohol for a specific period before receiving the injection.
  • Patients without severe liver disease.

Preparation

• Pre-Procedure Instructions:
  • Patients must abstain from opioids and alcohol for 7-10 days prior to the injection.
  • Inform the physician about all medications currently being taken.
• Diagnostic Tests/Assessments:
  • Liver function tests to ensure the absence of severe liver disease.
  • Physical examination and complete medical history review.

Procedure Description

• Step-by-Step Explanation:
  1. The patient checks in and reviews the procedure with the healthcare provider.
  2. The healthcare professional prepares the injection site, usually the gluteal muscle.
  3. Naltrexone depot powder is mixed with a liquid and loaded into a syringe.
  4. The prepared naltrexone is injected intramuscularly into the patient’s gluteal muscle.
• Tools/Equipment: Syringe, naltrexone depot formulation, alcohol swabs, gloves.
• Anesthesia/Sedation: Not typically required; the procedure may cause mild discomfort at the injection site.

Duration

• The entire procedure usually takes about 10-15 minutes.

Setting

• Performed in an outpatient clinic or medical office setting.

Personnel

• Healthcare professionals typically involved:
  • Physician or Nurse Practitioner (administers the injection)
  • Nurse or Medical Assistant (assists with preparation and patient care)

Risks and Complications

• Common Risks:
  • Pain or swelling at the injection site.
  • Mild to moderate allergic reactions.
• Rare Risks:
  • Severe allergic reactions.
  • Liver damage (rare but possible, necessitates liver function monitoring).
  • Injection site infection.
• Management:
  • Monitoring for allergic reactions and managing them appropriately.
  • Careful technique to prevent infections.

Benefits

• Expected Benefits: Reduced cravings for opioids and alcohol, decreased risk of relapse.
• Realization Timeframe: Benefits are usually seen within a few days to a week after the first injection.

Recovery

• Post-Procedure Care:
  • Monitor the injection site for any signs of infection.
  • Patients can resume normal activities almost immediately but should avoid intense physical activity for 24 hours.
• Expected Recovery Time: Immediate with minimal downtime.
• Follow-Up Appointments: Monthly injections are typically required, with periodic follow-up visits to assess efficacy and side effects.

Alternatives

• Other Treatment Options:
  • Oral naltrexone.
  • Buprenorphine or methadone for opioid dependence.
  • Behavioral therapy or counseling.
• Pros and Cons:
  • Depot naltrexone provides continuous coverage, versus oral medication requiring daily adherence.
  • Other medications may have different side-effect profiles or mechanisms of action.

Patient Experience

• During the Procedure:
  • Patients might feel a brief pinch or sting at the injection site.
• After the Procedure:
  • Mild soreness or swelling at the site.
  • Immediate relief in knowing that relapse prevention is actively managed.
• Pain Management/Comfort Measures:
  • Over-the-counter pain relief like acetaminophen or ibuprofen for post-injection discomfort.