SCI
Jonathan Tran, BS
Medical Student
University of California, Davis
Sacramento, California, United States
Zach Kaufman, MD
Resident Physician
UC Davis Dept. of PM&R
Sacramento, California, United States
Shane Stone, MD
PM&R Director of SCI
UC Davis
Sacramento, California, United States
Jonathan Tran, BS
University of California, Davis
Sacramento, California, United States
T12 ASIA A spinal cord injury and opioid use disorder
Case Description: A 26-year-old male presented after an abdominal gunshot wound resulting in a T12 ASIA A spinal cord injury (SCI). His history was notable for opioid use disorder (OUD), and he was seen by the addiction consult team. He was initiated on methadone after reporting prior adverse effects with buprenorphine. Despite the functional progress made at inpatient rehabilitation facility (IRF), methadone maintenance posed significant barriers given the patient’s new SCI and limited access to daily dosing clinics. To address these limitations, he was transitioned to extended-release naltrexone (XR-naltrexone). Notably, methadone was rapidly weaned, and XR-naltrexone was initiated without the prolonged opioid-free interval recommended in guidelines. The transition was well tolerated without withdrawal or adverse events. He has continued monthly XR-naltrexone therapy in SCI clinic without relapse.
Discussions: This is, to our knowledge, the first documented case of XR-naltrexone initiation for OUD during inpatient SCI rehabilitation. Unlike methadone or buprenorphine, XR-naltrexone does not require daily clinic attendance, a critical factor for patients facing new mobility limitations. While acute hospitals report higher rates of successful transition to medications such as naltrexone, preliminary evidence suggests that more nuance is needed in patient selection. XR-naltrexone is also increasingly underused compared to alternatives such as Suboxone, which is considered standard of care. In this case, it was successful given the patient’s limitations. Importantly, successful initiation occurred without the conventional week-long abstinence period, suggesting that under close medical supervision, shorter initiation protocols may be feasible.
Conclusions: IRFs represent a novel frontier for opioid weaning and OUD medication initiation. This case illustrates how tailored XR-naltrexone initiation in an IRF can overcome accessibility barriers and support long-term recovery in patients with complex disability. Future research should explore patient selection criteria and institutional protocols to expand OUD treatment at IRFs.
