Naltrexone is an opioid blocker that is FDA-approved for the treatment of alcoholism. However, it is also effective off-label for treating opioid use disorder. The medication comes in two forms: an oral pill (brand name ReVia) and an injectable version (XR naltrexone, or Vivitrol). XR naltrexone is composed of 380 mg of naltrexone, given as an intramuscular injection once a month. During that month, patients who try to use opioids will feel little if any high. This works well to prevent relapse if patients keep getting the shot.

People with alcohol use disorder are often smokers, and it can be very hard for patients to reduce their drinking and smoking simultaneously. In this study, the researchers hypothesized that topiramate, which has shown promise as an off-label treatment for nicotine and alcohol use independently, might work as a “silver bullet” for both ­problems.