If you are thinking of trying naltrexone treatment for alcohol or opioid use disorders, 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. Perhaps you are required to take drug tests for work and you are concerned that you might experience discrimination if you admit to being 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. Or you might simply be curious.
OK, So Can Naltrexone Be Detected?
The short answer is yes: any substance that is metabolized in your body can be detected by a drug test. 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 tests are usually administered by taking urine or saliva. 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 tests comes up positive, it should be followed with a confirmatory test, conducted in a lab by gas or liquid chromatography-mass spectrometry.
All of this is relevant because, typically, in order for a drug test to detect a substance, that substance must be specifically tested for. Naltrexone is not included in any of the typical testing panels, so it should not turn up—unless whomever is testing you specifically requests it for their own purposes. 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, but also note that there are no peer-reviewed studies to back these anecdotal findings.
What Are My Rights?
If you are being asked to take a drug test, you can decline to provide the sample, but you will then have to face the consequences, whether that means you don’t get the job you want, or get your probation violated. If you’re having trouble with the particular type of drug test 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), you might be able to ask to do a blood or oral fluid test instead. Generally speaking, however, that request does not have to be granted, and you may need to take the matter to court if it’s serious.
When it comes to the use of naltrexone, it 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 have to disclose your medication in order to be protected. 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, he could fire you for “dishonesty.”
When it comes to something like drug court or probation, they typically get to make up their own 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. But 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 and blocks the effects of opioids. This is rooted in stigma; opioid-based medications like buprenorphine and methadone are highly effective and do not result in intoxication when taken properly—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, 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! The reality is that, in most cases, it is not.