Alexander DeLuca, M.D.
    Addiction, Pain, & Public Health website  
[Home] [Library]  [Slides]  [Search]  [Medline]  [Links]
Statement of Purpose; Privacy policy; Statement of Ownership; Statement of Sponsorship; Advertising policy 

ReVia, car-wrecks & clean underwear - MM @ maelstrom.stjohns.edu - 6/2/2001

Tom B wrote:
"But just a note about Revia for all who are using it or plan to use it. Revia also blocks the effect of some anesthetics and severely modifies the effect of others. "

Good point, Tom. Fortunately, the effects of naltrexone (ReVia) are not long lasting. So, for predictable surgical or painful events, simply stop taking it 72 hours before you expect to need opiates (codeine, morphine, percoset, dilaudid, heroin, whatever) and they will 'work as advertised.'

While we're on the subject, (and so I don't get charged for another message), another question that comes up, usually from my heroin addicted patients who, consciously or unconsciously are reserving the right to use heroin 'in an emergency', but also from some alcoholic patients as well, is the oft-dreaded "WHAT IF I AM IN A CAR WRECK" scenario.

OK, IF you are in a car wreck:
1) make sure you have clean underwear on. (You did leave the house with clean underwear on didn't you? Your mother is ALWAYS watching.)

2) (and this is where the heroin addicts start to look confused) if you are in a car wreck YOU LIKELY NEED A EMERGENCY SURGICAL TEAM more than you need a shot of morphine, and said surgical team includes an anesthesiologist who can safely overwhelm the naltrexone blockade such that when / if you awaken you will be able to enjoy the benefits and pleasures of post-op opiate medications (given in sub-therapeutic doses too far apart, usually).

But seriously, Tom's suggestion that you carry a card, even a homemade one, that says "I am on naltrexone 50mg" or 100mg or whatever is wise and prudent - fear not, the hospital will do the "wallet biopsy" and find the card and call the 'gas guys' if necessary.