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Q & A: How Does Low Dose Naltrexone Work?

LDN is best classified as an immuno-regulator. It causes an increase in OGF levels - and OGF regulates proliferation of all cells, including immune cells (T-cells and B-cells). When immune cells are being produced in excess (leading to autoimmune conditions), OGF acts to slow down their proliferation. Whilst this can be construed as immune-suppression, it is most accurately described as immune-regulation.
Naltrexone passes through the blood brain barrier. It affects opioid receptors throughout the body.
For LDN to work, the full LDN dose must be delivered to the body in one go. Transdermal delivery methods by nature result in slow continuous delivery of a drug. This will result in continuous opiate receptor blockade - quite the opposite of the purpose of LDN which is to deliver a very short term blockade in order to create the beneficial rebound effect.
If LDN is effective for the condition being treated, then generally it is taken long term. Since it does not cure the disease, but rather regulate immune system function, it is possible that some patients may experience a relapse when stopping it, whilst others do not.
Many medications are used to manage chronic diseases and they don't always need to be taken continuously. When the disease enters a state of remission, it will often stay that way for a while even without the use of medication. LDN is no different than other medications in this regard.
LDN is not an illicit drug, so assuming the testing is looking for illicit drugs, it should not appear. However, you may wish to call the organization overseeing the drug testing and check the matter with them.