Submit Manuscript | http://medcraveonline.com Introduction Abuse and addiction to opioids, including prescription painkillers, heroin and synthetic opioids such as fentanyl, buprenorphine, oxycodone, constitute a serious crisis that affects public health and has economic repercussions. It is estimated that the number of opiate users and people with abuse of these substances in the last year is approximately 35.1 million people (range 28.3 million to 42.7 million). 1 The abuse of opioids remains a concern in many countries, particularly in the United States of America where shows an increase in the use of heroin and fentanyl, has resulted in an epidemic and an increase in related morbidity and mortality with opiates. 1 Opioids continue to be a major concern in south-west and central Asia and in eastern and south-eastern Europe. In the south-eastern Europe, almost three out of fve people who are on drug treatment are also under treatment for opioid use disorders. According to the “National Survey of Consumption of Drugs, Alcohol and Tobacco 2016-2017”, in Mexico, there is an accumulated incidence of opioid use in the population aged 12 to 65 years. 2 Naltrexone is a long-acting opiate antagonist and derived from thebaine with a structure very similar to oxymorphone. 3 Naltrexone has been used with a recommended daily oral dose of 50 mg in patients who have detoxifed from heroin. 4 Opioid effects can be blocked by naltrexone because of the methyl group. Methylnaltrexone antagonizes the peripheral μ receptor and has a lower affnity for the ĸ and δ receptors. Moreover, Naltrexone has better oral bioavailability and a longer duration of action than naloxone. However, previous studies showed that oral naltrexone had the lack of clinical success. 5,6 Therefore researchers started to search for developing sustained release technologies that would decrease compliance problems by reducing the number of dropout opportunities. Naltrexone implants might increase the clinical feasibility. This article describes the management protocol of acute abstinence symptoms in patients with a history of opioid use prior to naltrexone implant placement, 6 pellets with microspheres 200 mg each.Implants were donated to the Pain Management and Palliative care service in Hospital General de Occidente by the company: Esterimex Soluciones S de RL de CV and each patient had thorough information on the current status of implants and informed consent was obtained from the patients. J Anesth Crit Care Open Access. 2020;12(1):41‒44. 41 ©2020 Ornelas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Management protocol for the naltrexone ımplant in the patients with acute abstinence symptoms: Mexican case series Volume 12 Issue 1 - 2020 Guillermo Aréchiga Ornelas, 1 Mario Fajardo Pérez, 2 Jorge Bonilla Flores, 3 Ana Karen Santoyo Cueva, 4 Diana Romina Bucio Cedeño, 4 Carlos Garza Garibay, 4 Stephanie Victoria Gomez Rodriguez, 4 Juan Orlando Castillo Rodriguez, 4 Melissa Vega Perálta, 4 Ana Karen Cornejo Huerta, 4 Rocío Valenciano Cuevas, 4 Ramón Jayme Navarro Rojas, 4 Armando Longoria Robledo, 2 Ece Yamak Altinpulluk 4,5 1 Professor in the Department of Pain Management and Palliative Care, Hospital General de Occidente Zapopan, Mexico 2 Associate professor of the specialty, Móstoles University Hospital, Spain 3 Associate professor of the specialty, Hospital General de Occidente Zapopan, Mexico 4 Resident of the specialty of Pain Management and Palliative Care, Hospital General de Occidente Zapopan, Mexico Anesthesiologist and Research Fellow, Outcomes Research Department, Anesthesiology Institute, Cleveland Clinic, USA 5 Anesthesiologist and Research Fellow, Anesthesiology and Reanimation Department, Cerrahpasa Medical Faculty, Turkey Correspondence: Guillermo Aréchiga Ornelas, Pain Management and Palliative Care, University of Guadalajara Hospital General de Occidente Zapopan, Jalisco, Mexico, Email Received: February 04, 2020 | Published: February 10, 2020 Abstract Abuse and addiction to opioids, including prescription painkillers, heroin and synthetic opioids such as fentanyl, buprenorphine, constitute a serious crisis that affects public health and has economic repercussions. 1 Naltrexone implants are effective tools used in hospital environments and they can not only save patient´s lives but also maintain a prolonged effect, free of relapse and with better therapeutic adherence. The aim of this study is to describe that the management protocol of acute abstinence symptoms in patients with a history of opioid use prior to naltrexone implant placement. Keywords: implant naltrexone, addiction, opioids, health care workers, naloxone, abuse drugs Journal of Anesthesia & Critical Care: Open Access Case Report Open Access