If you’re considering naltrexone treatment for alcohol or opioid use disorder, you might be wondering if it can be detected on a drug test.
There are many reasons why someone could be concerned about a medication being detected on a drug test or drug screen. Perhaps you are required to take drug screens for work and you’re concerned that you might experience discrimination if they know you’re in recovery from a substance use disorder. Or maybe you are on probation or in drug court, and you are not certain whether this medication will be accepted. Maybe you have concerned family who want you to take drug tests for their own peace of mind. Or you might just be curious.
Okay, so can naltrexone be detected by a drug test?
The short (and strictly accurate) answer is yes: any substance that is metabolized in your body could potentially be detected by a drug screen. But in most cases, the functional answer is no.
When someone says “drug test,” that can mean a variety of testing types. In the workplace, drug screens are usually administered by taking urine or saliva samples. In court cases, urine and hair testing are common, though blood and saliva may also be utilized. For alcohol detection, breathalyzer tests are also commonly employed in a variety of settings.
Sometimes, urine and oral fluid (saliva) tests are conducted onsite, with automatic results. These are immunoassay tests, which use antibodies to detect the presence of a substance in the sample. They are referred to as screening tests because, although they can accurately identify the presence of certain drugs, they are also prone to false positives and other errors. If a screening test comes up positive, it should be followed with a confirmatory test, conducted in a lab using gas or liquid chromatography-mass spectrometry.
I know the science talk and complicated terms can be confusing, but all of this is relevant. In order for a drug test to detect a substance, the test or screen needs to be designed to look for it. None of the typical testing panels are designed to look for naltrexone, so it will not usually be detected. Not because it can’t be, but because they’re not looking for it. If you’re concerned that naltrexone is being tested for, you can always ask what type of panel is being conducted and what substances are included.
That said, however, it is possible for naltrexone to show up as a false positive on a screening test. A letter published in the Canadian Journal of Addiction Medicine in 2019 discusses some anecdotal evidence that naltrexone has occasionally screened positive for oxycodone or opiates. They attribute this to the structural similarity between naltrexone and oxycodone. In 2024, a case study in The Mental Health Clinician described a person who tested positive for opiates when taking naltrexone. So this can be a concern, even though it has not been shown to occur commonly.
What are my rights when I’m asked to take a drug screen?
If you are being asked to take a drug screen, you can decline to provide the sample. But having the legal right to decline doesn’t shield you from the possible consequences of that decision. That might mean that you don’t get the job you want, have to navigate your family’s distrust, or get your probation violated.
If your objection is to the particular type of drug screen requested, you may be able to request a different form of test, depending on who you are dealing with. For example, if you’re unable to provide a urine sample (which can be particularly difficult in the case of witnessed urine screens—a lot of us can’t pee under pressure), you might be able to request a blood or oral fluid test instead. Generally speaking, however, this kind of request does not have to be granted, so you may need to take the matter to court if your reason is serious.
Naltrexone is an FDA-approved, evidence-based treatment for opioid and alcohol addictions. This means that if you are taking it as prescribed by a licensed medical provider for a diagnosed opioid or alcohol use disorder, you are protected against discrimination by the Americans with Disabilities Act. That means nobody can, for example, deny you a job or say you’re an unfit parent solely based on the fact that you are taking naltrexone. When it comes to employment, the catch is that you would have to disclose your medication in order to qualify for ADA protection. If you were to get one of those rare false positives for oxycodone and then attribute it to a previously undisclosed naltrexone prescription, even if your employer verifies that the screen was false, they could fire you for “dishonesty.” As naltrexone is researched to treat more conditions, like Long COVID, Crohn’s disease, and several immune system disorders, it is possible that it will become more common in the future, and therefore even less likely to inspire this kind of response.
When it comes to something like drug court or probation, the people in charge typically make the rules. If you have a particularly dedicated attorney, she might be able to fight for your right to take a medication that is not typically allowed in your program. This isn’t as much of an issue for naltrexone as it is for buprenorphine and methadone. In fact, naltrexone enjoys the approval of many criminal justice and family court systems because it is not opioid-based, not habit-forming, and blocks the effects of opioids. To be clear, this preference for naltrexone is rooted in stigma. (Opioid-based medications like buprenorphine and methadone are highly effective and do not result in intoxication when taken properly, so distrust of them is based on bias against opioids and distrust of people with opioid use disorder.) But in this case, the stigma benefits people who use naltrexone.
That said, admitting to someone like an employer that you use naltrexone essentially means admitting that you have a substance use disorder. While it is illegal to discriminate against someone based on their diagnosis alone, that doesn’t mean it never happens. Discrimination can be hard to prove, especially in more subtle forms. If you think your work environment would not be supportive of your naltrexone use, but you are required to pass a drug test, it is entirely up to you whether you want to take the relatively small risk of a false positive that might potentially require you to disclose your medication.
If you’re unsure whether naltrexone is being tested for at your facility, just ask! In most cases, it is not, but knowing will give you peace of mind.