Since Low Dose Naltrexone (LDN) can upregulate endogenous opioid activity, very low dose naltrexone (VLNTX) in addition to methadone taper has been associated with attenuated withdrawal intensity during detoxification and better results after detoxification. Although VLNTX has been found ineffective in preventing relapse when administered alone and following detoxification, the transition to NTX treatment may be further improved by administering VLNTX during detoxification
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657183/
http://www.ncbi.nlm.nih.gov/pubmed/19283561
Does VLNTX during methadone detoxification improve withdrawal sintomatology, regardless of using ancillary medications?
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http://www.bluelight.org/vb/private.php?do=showpm&pmid=2075218
Depends what you mean by 'very low dose'. There are some papers suggesting that microgram doses can facilitate opiate detoxification but my experience has been with a NTX starting dose of 0.5mg, which is sometimes - but not often - enough to precipitate withdrawal symptoms in patients using heroin or methadone. Most patients needed 2-3mg before symptoms appeared. Buprenorphine users need even more. George O'Neil in Perth uses small, repeated doses of naloxone in his day-patient detox and NTX induction technique and I think he starts with 50mcg, titrated against patient response. However, VLDNTX is apparently not meant to precipitate withdrawal but to soften up the opiate receptors in some way. Of course, you can also start with 50mg of NTX and use oral, i/m or i/v sedation at various levels (as well as other symptom-control drugs like clonidine and octreotide) to minimise withdrawal discomfort. Or even full general anaesthesia, though absurdly exaggerated and extensively publicised claims from some organisations in the 1990s about long-term abstinence rates made many people suspicious about precipitated detox under GA. In the 1960s and 70s, generous sedation was pretty common in British NHS hospitals to help people get through withdrawal if they were finding it so difficult that they were thinking of withdrawing from treatment rather than from opiates.
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