Low-Dose Naltrexone (LDN)

LDN for PAWS, sleep, and mood — after acute withdrawal: what it is, how to get a prescription.

⚠️ This post is community information, not medical advice. Everything below is a starting point for your own research and a conversation with a qualified provider. People in this community have found LDN helpful, but individual situations vary, and your doctor (not a Discord post) should be the one making decisions about your care. Please verify what you read here against the linked sources, ask questions, and listen to your prescribing clinician.

LDN is one of the more interesting tools that may be worth looking into after you’re past acute withdrawal and into the long, slow part where things still don’t feel right. It’s not a withdrawal medication, it’s not a substitute for MAT, and it absolutely cannot be taken while there are still opioids on your receptors. But for PAWS, low mood, low energy, sleep issues, and that persistent “off” feeling that hangs around for months, a lot of people report finding it helpful. Whether it’s right for you is a question for a clinician.

What it is (general overview)

Naltrexone is an opioid antagonist. At the standard 50 mg dose, it blocks opioid receptors and is used to prevent relapse. At low doses (typically 1 to 4.5 mg), the proposed mechanism is different and somewhat paradoxical: by transiently blocking opioid receptors for a few hours, it’s thought to upregulate your body’s own endogenous opioid signaling, like endorphins and enkephalins. It’s also proposed to reduce neuroinflammation through a separate mechanism (TLR4 modulation on microglia). The mechanism is still being researched and isn’t fully settled. Some newer work suggests certain benefits may be independent of the endogenous opioid system entirely.

The general idea: it may nudge your own opioid system back toward producing what it should be producing on its own. That’s a system that’s commonly disrupted in PAWS.

Why people in this community look into it

After heavy use of 7-OH, pseudo, MGM-15, MIT-A, or similar, the endogenous opioid system gets suppressed. Your brain stops making its own endorphins because the receptors were being flooded externally. Once you stop, it takes weeks to months for that system to come back online, and that’s part of what PAWS is. Anhedonia, low motivation, low pain tolerance, sleep disruption, emotional flatness: all of these are consistent with a depleted endogenous opioid system.

LDN is one of the few tools that may target that mechanism specifically. Commonly reported benefits in recovery contexts (not all clinically proven, varies by person):

Reduced cravings and reduced “low-grade misery” of PAWS
Improved mood and motivation
Better sleep quality (after the first week or two, see below)
Reduced inflammation and chronic pain
Some data on reduced relapse rates when used post-detox

Whether any of these apply to your specific situation is a question worth bringing to a provider familiar with LDN.

Critical timing, please discuss this with a doctor before starting

LDN will precipitate withdrawal if there are opioids on your receptors. This includes:

7-OH, pseudo, MGM-15, MIT-A, and any other kratom-derived synthetic
Suboxone/buprenorphine
Methadone
All other opioids

The general guidance is 7 to 10 days fully opioid-free before starting LDN, but the right washout for your situation depends on what you’ve been on, how long, and at what dose. Your prescriber should make that call. For the long-half-life synthetics (MGM-15, MIT-A), longer washouts are commonly recommended. If you’re on Suboxone, that’s its own conversation with your prescriber.

Practical stuff (general info, your provider’s protocol takes precedence)

Typical starting dose: often 1.5 mg at bedtime, titrated up over a few weeks toward 3 to 4.5 mg. Some people do best at lower doses; not everyone needs the full 4.5. Dosing should be set by your prescriber based on your situation.
Often dosed at night because vivid dreams and sleep disruption are common in the first 1 to 2 weeks. Some people switch to morning dosing if sleep doesn’t settle. Ask your provider.
Side effects reported in studies and patient experience are usually mild: vivid dreams, headache, GI stuff early on, mostly resolving within 2 weeks. Report anything unusual to your prescriber.
Give it time. Benefits, if they happen, often take 4 to 8 weeks to fully show up. It’s a slow rebuild, not a switch flip.
Carry an ID card or note that you take LDN. If you ever need emergency pain management, providers need to know, because standard opioid analgesics will be partially or fully blocked.

How to get it

LDN is not commercially manufactured at low doses. The only FDA-approved naltrexone product is the 50 mg tablet for opioid/alcohol use disorder. To get LDN you need:

A prescription from a provider willing to prescribe it off-label.
A 503A compounding pharmacy to actually make it at the low dose.

Two main routes to a prescription:

Telehealth platforms. AgelessRx is the most commonly mentioned one. Online intake, provider review, ships compounded LDN directly. Cash-pay, no insurance. Other telehealth options exist and the landscape changes fast; do your own research on what’s reputable and available in your state.
Your own provider. Primary care, addiction medicine, pain management, or functional medicine docs are the most likely to be familiar with LDN. The LDN Research Trust maintains a provider directory and a pharmacy directory if your current doc isn’t familiar with it. This is the single best independent resource if you want to go through your own healthcare instead of a telehealth platform.

Examples of compounding pharmacies that make LDN: CareFirst Specialty Pharmacy, Valor Compounding, Belmar Pharmacy, Pharmacy Solutions. Many others exist; your prescriber may already have a preferred one.

Insurance rarely covers compounded LDN, but cash prices are typically reasonable, usually $30 to $60/month depending on the pharmacy.

What LDN is not

Not a replacement for MAT. Don’t change your treatment plan based on a Discord post. Talk to your prescriber.
Not a withdrawal medication. It will make withdrawal worse, not better, if started too early.
Not a magic bullet. It helps some people with PAWS and not everyone. Sleep, exercise, nutrition, therapy, and time still do most of the heavy lifting.
Not appropriate for everyone, especially people with liver issues, certain medications, or other specific conditions. Your provider needs your full medical picture to make that call.
Not the same as ULDN. Ultra-Low-Dose Naltrexone uses microgram doses (about 1,000× smaller) and is taken with opioids to reduce tolerance or smooth a taper. Different dose, different timing, different use case. Read #ultra-low-dose-naltrexone if you’re considering it.