Medication-Assisted Treatment: Naltrexone to treat Methamphetamine Addiction?

This page explains how naltrexone may help reduce methamphetamine cravings by blocking opioid receptors involved in the brain’s reward response. It clarifies that naltrexone is not FDA-approved for meth addiction and is used off-label, with the strongest research support coming from its combination with bupropion. It cites the ADAPT-2 trial (NEJM, 2021), which found a 13.6% treatment response with naltrexone plus bupropion compared to 2.5% with placebo. The page compares oral naltrexone to the monthly Vivitrol injection, noting Vivitrol’s required 7–10 day opioid-free period and naltrexone’s liver contraindication risk. It also outlines who shouldn’t take naltrexone, questions to ask a provider, and why medication works best alongside detox, therapy, and structured support. The page closes by directing readers to ask Chapter 5 Recovery’s admissions team whether naltrexone-assisted treatment fits their situation.

You’ve been reading about this for weeks. You’ve seen the word “naltrexone” pop up in a news story, a forum thread, maybe from a doctor. What you really want to know is whether a medication can make cravings easier to carry.

That’s a fair question, and the answer is measured. There is real evidence here. It’s just important to understand what naltrexone can and can’t do, so you can decide if it’s worth asking about.

This page walks through how naltrexone works, what the studies actually found, how the pill compares to the monthly shot, and who shouldn’t take it. You’ll also get questions to bring to a provider, so the conversation feels less overwhelming.

How Naltrexone Affects Meth Cravings

Naltrexone is an opioid antagonist. That means it blocks the opioid receptors in your brain, the same ones tied to reward and pleasure.

Meth doesn’t act directly on those receptors the way heroin or oxycodone does. But your brain’s opioid system still seems to shape how rewarding meth feels and how strong cravings get. By blocking that system, naltrexone appears to take some of the edge off.

In everyday terms, this can look like:

• Cravings that feel less urgent
• A weaker high if you do use, which may reduce the pull to keep going
• Less physical reactivity, like a racing heart, when you run into triggers

Here’s the honest part. Naltrexone doesn’t erase the wish to use. It’s a tool that can make cravings more manageable, not a switch that turns them off.

That distinction matters. If you go in expecting a cure, the modest effect can feel like a letdown. If you go in expecting a little more room to breathe, it can be genuinely useful.

What the Research Shows: Alone vs. With Bupropion

Let’s be straight about the evidence. Naltrexone on its own has shown limited effect on methamphetamine use in clinical research. The stronger data comes from pairing it with bupropion, a medication that affects dopamine and norepinephrine.

The largest study on this pairing is the ADAPT-2 trial, a 12-week, multi-site study funded by the National Institute on Drug Abuse and published in the New England Journal of Medicine (Trivedi et al., 2021). Participants received extended-release injectable naltrexone plus oral bupropion, and their urine tests were compared against a placebo group.

Here’s what researchers found:

• 13.6% of people on naltrexone plus bupropion had a treatment response (mostly meth-negative urine samples), compared with 2.5% on placebo
• People on the combination also reported lower craving scores
• Side effects were mostly mild to moderate, such as nausea and tremor

That 13.6% figure is not a “success rate” in the way you might hope. It reflects a strict clinical definition of response over 12 weeks. What it tells you is real, though: the combination clearly beat placebo.

It’s also worth repeating. No medication is currently FDA-approved for methamphetamine use disorder (NIDA). Naltrexone and bupropion are both approved for other conditions and used off-label here, based on this research.

If you want the bigger picture on where medications fit into methamphetamine addiction treatment, it helps to see naltrexone as one option among several being studied, not the whole answer.

Oral Naltrexone vs. Vivitrol Injection

Naltrexone comes in two forms. One is a daily pill. The other is Vivitrol, an extended-release injection given once a month. Both contain the same active medication, but they act differently in your body.

The daily pill gives you flexibility. If a side effect shows up, you can stop and it clears fairly quickly. The trade-off is that it depends on you remembering a dose every single day.

Vivitrol removes that daily decision. Once it’s injected, though, you can’t take it back. The effects taper slowly on their own.

That opioid-free window is important. Starting naltrexone in either form while opioids are still in your system can trigger sudden, severe withdrawal (FDA Vivitrol label, 2022).

This is one reason naltrexone-based treatment usually begins after a supervised medical detox. Your care team can confirm it’s safe before the first dose.

Side Effects and Who Shouldn’t Take It

Most people tolerate naltrexone reasonably well. Still, it isn’t the right fit for everyone, and you deserve to know the full picture.

Common side effects include:

• Nausea, especially after the first dose
• Headache or dizziness
• Fatigue or trouble sleeping
• Joint or muscle pain
• Lower appetite

Some risks are more serious. The FDA label for Vivitrol notes a liver contraindication risk, since naltrexone has been linked to cases of hepatitis and liver dysfunction. If you have any liver history, your provider will weigh that carefully and monitor your liver during treatment.

Naltrexone is also not right if you:

• Are currently using opioids or are physically dependent on them
• Are in acute opioid withdrawal
• Have had a bad reaction to naltrexone before

One more thing that matters day to day. Because naltrexone blocks opioid receptors, it also blocks opioid pain medication. If you ever need surgery or emergency pain care while on it, your medical team must know.

None of this is meant to scare you away. It’s meant to help you ask the right questions, so the decision is made with a provider who knows your health.