ARI SHAPIRO, HOST:
The opioid epidemic has left doctors looking for other painkillers that are both safe and effective. One alternative getting attention is an older generic drug, naltrexone. Reporter Alex Smith explains naltrexone is a surprising choice for pain since it's commonly used to treat opioid addiction.
ALEX SMITH, BYLINE: Fifty-year-old Lori Pinkley of Kansas City, Mo., has struggled with puzzling chronic pain since she was a teenager. Over the years, doctors diagnosed her with lots of possible causes, but she never found a surgery or pill that totally relieved her pain.
LORI PINKLEY: I hate opioids with a passion - absolute passion.
SMITH: Recently, she decided to try an out-of-the-box remedy, naltrexone, which is usually used to treat addiction. But it's not usually available in the doses that chronic pain patients need. In a YouTube video, a do-it-yourselfer shows how to turn one big pill into tiny fractional doses of naltrexone to make a low-dose version of the drug.
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UNIDENTIFIED PERSON: We're going to put it in this thing that cuts the pill in half, and we're going to cut it right in half. It's got a little razor blade in there.
SMITH: This kind of information has circulated underground through wellness centers and word of mouth since the '80s. Naltrexone might seem like exactly the wrong drug to use. When taken for addiction, it works by shutting down opioid receptors, some of the brain's most important feel-good regions. In tiny doses, though, naltrexone seems to work completely differently.
University of Kansas pain specialist Dr. Andrea Nicol has recently started prescribing low-dose naltrexone to her patients.
ANDREA NICOL: What it's felt to do is not shut down the system but rather restore some balance to the opioid system.
SMITH: In the past few years, as interest in alternatives to opioids has grown, there's been a flood of new studies on low-dose naltrexone. Pain management specialist Bruce Vrooman has reviewed the current research on low-dose naltrexone. Vrooman says that when it comes to treating complex chronic pain, low-dose naltrexone appears to be more effective and well-tolerated than the big-name opioids that dominated pain management for decades.
BRUCE VROOMAN: And those patients may report that this is, indeed, a game changer. It may truly help them with their activities, help them feel better.
SMITH: So how does it work? Scientists think that in many chronic pain patients, the central nervous system gets overworked and agitated. Pain signals get stuck in an out-of-control feedback loop that drowns out the body's natural pain-relieving systems. But it's thought that low doses of naltrexone damp down that agitation and help kickstart the body's production of pain-killing endorphins, all with relatively minor side effects. Vrooman thinks it's time for low-dose naltrexone to undergo the same kind of large-scale studies that new prescription drugs receive.
VROOMAN: There's a need for prospective studies and randomized controlled trials to evaluate the clinical effectiveness of low-dose naltrexone, particularly when considered as an opioid alternative.
SMITH: Despite the promising research, drug companies have shown little interest in producing naltrexone in low doses. That leaves many patients making it for themselves or, like Lori Pinkley, having it custom-made at compounding pharmacies. It's a hassle, but she says it's worth it.
PINKLEY: I can go from having days that I really don't want to get out of bed because I hurt so bad to, within a half hour of taking it, I'm up and running, moving around, on the computer, you know, able to do stuff.
SMITH: Pinkley has been taking low-dose naltrexone for about a year and a half now. She wishes more people at least knew it's an option.
For NPR News, I'm Alex Smith in Kansas City.
SHAPIRO: And this story is part of a reporting partnership between NPR, KCUR and Kaiser Health News.
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