Why is oral naltrexone not widely used for treating opioid use disorder despite its advantages?

Oral naltrexone is a medication that blocks the effects of opioids and can be beneficial in the treatment of opioid use disorder. However, its use is limited mainly due to challenges related to patient acceptance and adherence to the treatment regimen. Many patients may find it difficult to consistently take an oral medication, particularly in the context of addiction recovery. The experience of withdrawal symptoms and cravings can negatively impact their willingness to adhere to the treatment. Additionally, the fact that naltrexone does not alleviate cravings the way some other treatments do can further contribute to a lack of patient acceptance, as it may not feel as supportive during the recovery process compared to options like methadone or buprenorphine, which have a more favorable profile for managing withdrawal and cravings.

In contrast, the other options presented do not accurately reflect the main reason for the limited use of oral naltrexone. It is not that the medication is ineffective overall, as it can be beneficial for some patients, but rather that its delivery method and the nature of patient engagement in the treatment process pose significant barriers. Being highly addictive is inaccurate as naltrexone is specifically designed to counteract the effects of addictive opioids. Lastly, the legality of naltrexone