This one is from Nick about LDN, low-dose naltrexone. “Can you speak to dosage and duration after six to nine months? What’s this an extended duration of LDN without long-term studies? If patients are already prescribed opioids, do you have them stop while using LDN?”
Chris: Great question. I just happen to have this book here. I was reading it this morning. You probably won’t be able to see it and not everyone’s watching anyways but it’s called The LDN Book: How a Little-Known Generic Drug—Lose Dose Naltrexone—Could Revolutionize Treatment for Autoimmune Diseases, Cancer, Autism, Depression, and More. It’s edited by Linda Elsegood, but it’s a number of essays about how to use LDN clinically, and there’s history and pharmacology, there’s a chapter on MS and lupus, one on IBD, which would be good in the context of this question, chronic fatigue syndrome, fibromyalgia, thyroid disorders, restless leg syndrome, depression, autism, cancer, and their contributors are all physicians who are have a ton of experience working with LDN. Dr. Kent Holtorf you probably know if you’re familiar with the chronic fatigue syndrome and fibromyalgia community, Leonard Weinstock for restless leg syndrome. Jill Smith for LDN and Crohn’s disease, both in adults and children. It’s a really good book. I recommend it.
But to answer your questions, there are many patients who’ve been on LDN for years and years without any known adverse effects. I believe it’s a very safe medication, and in many cases, the patient is choosing between taking LDN versus a globally immunosuppressive drug like prednisone or even a biologic like Remicade or Humira for Crohn’s disease. In my mind, that’s just an absolute no-brainer. If you can control the symptoms and be in remission with LDN, even if you have to take that for your entire life, that is so much better than the alternative of having to take a 5-ASA like Pentasa, a biologic, or a steroid, or even something like Entocort, which is more of a topical steroid. I personally know no drug is risk-free, but when you look at the studies on LDN, I think it’s pretty safe.
For opiates, that’s a more complicated question. There’s some mixed research on that and clinical experience as well. I mean, if you understand the mechanism of LDN that taking opiates just wouldn’t even work or be effective … but there’s more to it than that, and I don’t have a lot of experience because prescribing is outside of my scope of practice. But even with Amy and Tracey, the clinicians who work with me and do prescribe, we don’t have a lot of experience managing patients who are taking opioids and LDN at the same time, so I can’t really speak to that.