Low Dose Naltrexone in Washington and Oregon

LDN prescribing, titration and monitoring by telehealth.

Most people who ask me about LDN have already read about it for months and cannot find anyone willing to write for it. Their doctor has either not heard of it, or has heard of it and does not want the conversation.

I prescribe LDN by telehealth for patients in Washington and Oregon.

What it is

Naltrexone at 1 to 4.5 mg, roughly a tenth of the dose used for opioid or alcohol dependence. At that dose it briefly blocks opioid receptors overnight, and the body's response appears to modulate immune signaling and reduce inflammatory activity in the central nervous system. It is compounded, because it is not manufactured at that strength.

What the evidence supports

The strongest human data is in fibromyalgia, where small controlled trials show meaningful reduction in pain and improved quality of life. There is reasonable evidence in Crohn's disease, and a growing but still early signal in multiple sclerosis, complex regional pain syndrome and long COVID.

In oncology the evidence is thinner and I will say that plainly. The mechanistic work is interesting and there are case series, but there is no large trial showing LDN changes cancer outcomes. What I see clinically is that some patients report better sleep, less pain and more energy during treatment. That is worth something, and LDN is low cost and generally well tolerated, so for many people it is a reasonable thing to try. It is not a cancer treatment and I do not present it as one.

Who asks about it

Fibromyalgia. Hashimoto's and other autoimmune disease. Crohn's and ulcerative colitis. Multiple sclerosis. Long COVID. Chronic fatigue. Chronic pain. And patients in cancer treatment or survivorship looking for something that takes the edge off inflammation and pain without adding sedation.

What a visit involves

I review your history, current medications and what you are actually trying to solve. LDN interacts with opioid pain medication, which is the interaction that matters most, so we work through that first. I start low, usually 0.5 to 1.5 mg, and titrate based on how you respond. Vivid dreams and sleep disruption in the first two weeks are common and usually settle. I send the prescription to a compounding pharmacy and we recheck in four to six weeks.

Cost

Initial consultation is $350 for 60 minutes. Follow-ups start at $120. Visits are self-pay and I do not bill insurance. Compounded LDN typically runs $30 to $60 a month depending on the pharmacy.

Washington and Oregon

I can prescribe for patients in Washington and Oregon. If you live elsewhere I can review your case and give guidance, but I cannot write the prescription.

Book a free 15-minute consult to find out whether LDN is a reasonable fit for you.