Naltrexone, a ยต-opioid receptor antagonist, is a promising agent for methamphetamine-using
and binge-drinking men who have sex with men (MSM). Naltrexone has shown efficacy in reducing
relapse to amphetamines and is FDA-approved for alcohol dependence. Oral naltrexone is
inexpensive and has few toxicities but the standard daily regimen for naltrexone is
problematic as patients forget to take the medication. Given the challenges in daily dosing,
alternate regimen schedules have been proposed to increase efficacy and expand the population
that may benefit from this pharmacologic agent. One approach is intermittent targeted
administration of naltrexone, whereby individuals take the medication as-needed in
anticipation of substance use or during periods of craving. Administration of naltrexone
prior to exposure to amphetamines significantly attenuates craving and targeted naltrexone
has shown efficacy in reducing heavy alcohol use. However, there have been no studies
assessing intermittent targeted dosing of naltrexone among methamphetamine-using and
binge-drinking MSM. Polysubstance use patterns are common among MSM, and studies among those
who abuse more than one substance are urgently needed. The aims of this study are to
determine whether targeted dosing of naltrexone is feasible, tolerable and acceptable among
non-dependent methamphetamine-using and binge-drinking MSM.