Hi, Dr. Smith:

Quote: "Were you on any kind of opioid medication within 7 days of them giving you the patch with the naltrexone in it?" Before I was given the fentanyl patches with naltrexone in them, I was using the Janssen Duragesic fentanyl patches. The clinical trial was reserved for people who were using fentanyl patches (at that time, there were no generic fentanyl patches). Johnson & Johnson wanted to compare the fentanyl patches without naltrexone to the fentanyl patches with naltrexone.

Quote: "If so, the naltrexone can induce immediate withdrawal symptoms." The doctors who were taking care of the clinical trial told the Emergency Room doctors that the naltrexone was not supposed to get in the blood. In this case, replied one of the ER doctors, how could the naltrexone make the fentanyl more effective (this is what the clinical trial doctors claimed the naltrexone was supposed to do). The ER doctors thought that what the clinical trial doctors were claiming (the naltrexone supposedly making the fentanyl more effective) did not make any sense. The ER doctors thought the same thing as you, that is, that the naltrexone caused immediate withdrawal symptoms, which made me feel very, very sick.

Quote: "My understanding is that it's supposed to be given only with first-time opioid use, or with a carefully monitored switching procedure to avoid such a reaction." I did not know this. Did the clinical trial doctors and did Johnson & Johnson know this? They should have! Many people know that paramedics often use the naltrexone to reverse the overdose of heroin addicts. Of course, that must cause withdrawal symptoms in these addicts.

Quote: "The idea of adding LD neltrexone to opioids is that it eliminates the euphoric effects and retards/prevents tolerance to the opioids." The ER doctors thought they added the naltrexone to the fentanyl patches (at that time, these patches had a reservoir with the fentanyl in it) so that if a drug addict tampers with the patches to try to get high, the naltrexone would somehow get in the blood, mix with the fentanyl, and make it ineffective to protect the drug addicts from death by overdose from getting the fentanyl all at once. This is a bit confusing to me, but I think what the clinical trial doctors said is not clear. There is a lie or hiding the truth somewhere.