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I have also treated addicts who may have had gastric bypass, the place that the first section of the intestine is bypassed and also the stomach contents empty in to a more distal section of the small intestine. In such cases the naloxone escapes ?first pass metabolism', the task with normal anatomy in which the drug is taken up with the duodenum and transferred straight away to the liver with the portal vein, where it really is quickly and completely destroyed. After gastric bypass naloxone can be taken on by areas of the intestine that aren't served through the portal system, causing blood levels of naloxone sufficient to cause brief, relatively mild withdrawal symptoms.

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