In medicine, it is safe to say we all stand on the broad shoulders of mentors, past and present. Taking that statement further, I also stand on the shoulders of the patients that were willing to share with transparency and in doing so, trusted me with their care. It is that scaffolding that holds me up.
My continued mission is to treat without judgement and to give all that I can, in a medical and social environment that has been less than understanding.
We currently treat patients in the state of California.
Listen to Kelly Neil's interview on the LDN Radio Show .
In this interview, Kelly is interviewed about her practice, HIMC, LDN and it's many uses, and she even talks about TSM! This podcast interview was recorded in London, please turn up your volume.
What is Naltrexone?
Naltrexone is an FDA approved medication whose chemical structure almost exactly matches an
endorphin that our body makes naturally. Endorphins are our happy hormones, kind of like natural opioids. They are released when we are doing something that makes us feel good, like running, and for some people who are genetically predisposed, when they drink alcohol.
How dose naltrexone work?
Naltrexone matches this natural endorphin so closely that it actually binds to one class of endorphin receptors. It does not activate them, and there is no potential for addiction, and in fact the opposite
occurs. By binding them, it locks them. So when a patient takes an opiate, they are unaffected. FDA was approved in 1984 for the treatment of opioid addiction. This was followed by the approval of naltrexone
for the treatment of alcohol dependence in 1994.
What is Alcohol Use Disorder (AUD)?
Alcohol Use Disorder is the medically accepted term for when alcohol consumption causes problems. This can include excess alcohol use affecting health or social functioning, alcohol cravings, tolerance, or withdrawal. These disorders encompasses problem drinking, binge drinking, heavy drinking, and alcohol dependence. One in three people in the US will meet the criteria for AUD in their lifetime.
What is Targeted Dose Naltrexone?
Targeted dose naltrexone involves taking one 50mg tablet of naltrexone one hour daily before the first drink of the day. The medicine binds to the endorphin receptors, locks them, and blocks the endorphins from having any effects. For a patient who has endorphin-mediated drinking (meaning that endorphins are released when they drink), the endorphins are blocked from reaching the receptors. This prevents the positive reinforcing effects of alcohol on the brain. Over time, the brain learns that alcohol no longer equals endorphins. By a process called pharmacological extinction, the brain no longer craves alcohol. This specific dosing of naltrexone before alcohol is also known the The Sinclair Method (TSM), named after Dr John David Sinclair PhD, on whose research the method is based.
What is the advantage of TSM?
With targeted dose naltrexone, treatment does not require prior abstinence. Patients gradually drink less over time, leading to a gradual detoxification without withdrawal symptoms. The treatment does not require admission to a costly rehabilitation center, and it does not require any time off of work. It allows patients to maintain their dignity and privacy. It can be done in a primary care or Telemedicine setting, with basic instructions and guidance from a trained clinician.
How long does it take to work?
Pharmacological extinction can take anywhere from 3-6 months to be complete. Patients who are fast responders will often notice steeper declines in their drinking that can occur in the first month (sometimes in the first week).
How likely is this to work for me?
Success rates are reported at upwards of 70% in the literature. Potential patients need to discuss the treatment with a clinician to determine if they are a good candidate for naltrexone.
What is LDN?
Low dose naltrexone (LDN) is a promising treatment for patients suffering from a wide range of illnesses. Naltrexone was originally developed in 1963 and approved by the FDA in 1984 for the treatment of drug addiction. It has been found that in very small doses it can have positive effects on the body’s immune system as well as many other body systems.
How does it work?
LDN is unique in that it uses the body’s own natural endorphin system to influence certain processes in the body and promote healing. It also has been found to inhibit what are called glial cells in our central nervous system. These cells when over-stimulated and not functioning properly can cause inflammation, immune system dysfunction, and heightened pain responses.
How is it taken?
LDN is prescribed in a dose that varies based on the patient and the condition being treated (typically between 1.5mg to 4.5mg per day). Patients who take it at bedtime may occasionally experience vivid dreams or sleep disturbances. In those patients the dose can be given in the morning or another time of day. Other side effects are minimal and uncommon.
Using naltrexone in low dose form is called “off-label” because the original FDA approval was for a dose of 50mg per day or higher and was only for the treatment of drug addiction. Because naltrexone is only commercially available in 50mg tablets, the small dose must be made specially at what is called a compounding pharmacy. It is not covered by insurance, but it is very affordable (the pharmacy we use charges about $24 for 30 capsules).
What is LDN used to treat?
LDN has been used for decades as a treatment for many inflammatory and autoimmune disorders. We have good articles published showing definite benefit in patients with Crohn’s disease and fibromyalgia. One study shows improvement in quality of life in patients with multiple sclerosis. In addition there are several published case reports showing benefit in other conditions.
As more and more chronic illnesses are being determined to be due to underlying chronic inflammation and immune dysfunction, the potential is there for a benefit in a wide range of conditions.
Will LDN be approved by the FDA for use at low dosage for treating other conditions?
It is not likely that this will happen anytime soon. The formal studies that the FDA requires even to approve an existing medicine for use in another condition are very costly. Without the support of large pharmaceutical companies, there is no funding for these trials. Large companies would not profit from the development and sale of LDN because it is already available in a generic inexpensive form. In addition, LDN competes with other medications that are very profitable to pharmaceutical companies, so it would not be in their interest to promote the drug.