Has the time come for Vivitrol to become the “go-to” addiction treatment of choice? According to a brand-new study published just this month in The Lancet, Vivitrol is even better at preventing relapse than buprenorphine-based Suboxone. After a six-month study, results showed that compared to patients receiving Suboxone, patients given Vivitrol relapsed at a lower rate – 52% to 56%. Suboxone pills are a combination formulation of buprenorphine and naloxone that is prescribed to help opioid addicts reduce or stop their drug use. The buprenorphine eases drug cravings, and the naloxone is included to deter misuse of the medication. Along with methadone, Suboxone is one of the top Opioid Replacement Therapies (ORTs) used to address opioid addiction. This is the first USstudy to directly compare these medications, although the Journal of American Medicine published a smaller Norwegian study in October 2017. Working independently, both research teams reached the same conclusion – both Suboxone and Vivitrol are equally effective at treating opioid addiction. Therefore, both medications are viable options during Medical Assisted Treatment. (MAT). Dr. Joshua Lee, a Professor at New York University and the lead author of the study, says “We’ve had trials of each one, but not together. Once people were on either one, they did reasonably well over time.” Likewise, Dr. Nora Volkow, the Director of the National Institute on Drug Abuse, remarked, “This study removes a barrier, the belief that (Vivitrol) was not as good a medication.” This comparative study was funded by the NIDA.
What Is Vivitrol?
Vivitrol is the brand name of an extended-release once-a-month injection of naltrexone, a medication that completely blocks the intoxicating and pleasurable effects of opioids such as heroin or prescription painkillers. It also greatly reduces drug cravings. In other words, once they receive a Vivitrol injection, opioid addicts won’t be able to get “high” for the next 4 weeks. By reducing cravings and eliminating the pleasure of opioid abuse, the goal is to take away any motivation to use drugs.
Why Are Opioids so Addictive?
All substances of abuse – including opioids – are addictive because consumption causes massive amounts of dopamine to be released, resulting in a profound sense of euphoria and well-being. Dopamine is the neurotransmitter associated with pleasure, learning, memory, and motivation. How does this result in addiction? The opioid abuser’s brain learns to link the memory of how using the opioid results in an immediate reward – a pleasurable high. This is when choice is still involved. Remembering how much they liked the experience, they use and abuse, the drug regularly. However, over time, the continuous artificial inflation of dopamine levels causes the body to stop producing dopamine naturally. This means that without the drug, the person cannot experience pleasure or even function normally. This also means that when the drug isn’t available or when the person tries to stop, they go into drug withdrawal, often within a matter of hours. They either have to use again, or suffer painfully-uncomfortable symptoms. Where they once used drugs to feel good, now they must use drugs to keep from feeling bad. This is the motivation to keep using. Choice now has very little to do with it. Even when the to quit, their compulsion the pain of withdrawal and cause them to relapse.
How Does Vivitrol Help with Opioid Addiction?
Vivitrol and other medications containing naltrexone are opioid antagonists. This means they bind to the opioid receptors within the brain and block the effects of all opioids – heroin and prescription pain medications such as Vicodin or OxyContin. And, because Vivitrol is formulated for extended-release, this opioid barrier lasts for a month. Unlike methadone and Suboxone, Vivitrol is NOT an opioid. This is important distinction, because it means that Vivitrol does not:
- Trigger dopamine release
- Allow the user to get high
- Depress breathing
- Cause a physical dependence
- Result in addiction
In fact, the Substance Abuse and Mental Health Services Administration says that Vivitrol has “no abuse and diversion potential”.
Opioid Medications Like Suboxone and Methadone Work Differently
Even though it is the best-known opioid treatment medication, Methadone is a powerful opioid full agonist. This means that it is very addictive, just like the opioid drugs it replaces. In fact, the reason why methadone is not available as a take-home prescription is because of its high potential for misuse and addiction. The risk of fatal overdose on methadone is a real concern. Like other opioids, methadone suppresses breathing, and death can occur at levels of abuse or when other opioids are also taken. In 2014, for example, almost 1 out of every 4 opioid overdose deaths involved methadone. Similarly, buprenorphine medications like Subutex or Suboxone are also synthetic opioids classified as opioid partial agonists. This means they present a lowered risk of misuse, addiction, and overdose. There are still concerns about buprenorphine medications. Long-term use can result in dependence. And, if the medication is abruptly discontinued, the user can very quickly suffer withdrawal symptoms. How often on buprenorphine drugs of abuse? A third of people seeking opioid treatment have used buprenorphine to get high within the previous 30 days prior to treatment. Suboxone is also a popular drug of misuse, even though its formulation is “abuse-deterrent”. It is often used by addicts who want to stay functional and not get “dope sick” when heroin isn’t available. In other words, Suboxone is used to maintain their addiction, rather than support their sobriety A St. Louis-area addiction specialist, says, “…there’s more Suboxone on the street than in pharmacies. Most of the heroin dealers are diversified now. They offer you a choice of Suboxone and heroin.”
Is Vivitrol Effective?
When comparing the effectiveness of addiction counseling alone compared to a combination of counseling and a Vivitrol injection schedule, a six-month double-blind clinical study among patients who were opioid-dependent found:
- Opioid-free weeks: 35% of counseling/placebo patients vs 90% of Vivitrol/counseling patients
- Fewer opioid cravings: 3% vs 55%
- Length of treatment stay: 96 days vs 168 days
Compared to those receiving Vivitrol injections, patients given the placebo were 17 times more likely to relapse. A different study found that 2 out of every 3 patients given naltrexone medications successfully complete opioid rehab. Of special significance, when they receive both naltrexone and clonidine, the “graduation” rate increases to 85%.
Can Vivitrol Help with Other Addictions?
Vivitrol is also an effective medication option for the treatment of several other substance abuse and behavioral disorders, including:
- Alcohol – Vivitrol injections help reduce the:
- Number of drinking days
- Amount of alcohol consumed
- Frequency of heavy or binge-drinking
- Cocaine– According to the Journal of Pharmacology and Experimental Therapeutics, naltrexone , is a “promising treatment for prevention of cocaine relapse”.
- Methamphetamines
- Pornography addiction
- Kleptomania
- Problematic gambling
- Non-suicidal self-injurious behaviors
- Compulsive hair-pulling
The fact that Vivitrol helps with other addictions and behaviors gives it a significant advantage over other anti-addiction medications. Methadone has no other recovery-related applications, and Suboxone’s only other additional benefit is that it also seems to help with cocaine cravings.
Other Comparative Benefits of Vivitrol
Compared to other addiction recovery medications options, Vivitrol has other significant advantages:
- It is easier to stay compliant – A person gets their entire monthly dosage of Vivitrol with a single doctor visit.
With methadone, patients need to make a daily trip to the methadone clinic. And what Suboxone, the need to remember to take it every day. With either of the opioid medications, missing a single dose can lead to withdrawal, and possibly, a relapse.
- Vivitrol is available EVERYWHERE – Any physician can prescribe Vivitrol.
Methadone, on the other hand, is only dispensed at designated clinics. Any doctor wanting to prescribe buprenorphine medications first needs additional training and certification. And, during the first year following certification, there are limited to only 30 opioid patients at a time.
Only about 3% of US doctors are legally allowed to prescribe buprenorphine. Some states have less than 20 properly-certified doctors.
- Vivitrol promotes abstinence – With Vivitrol, a person’s tolerance for opioids is greatly reduced, so they are instructed to avoid ALL opioids. This leads to a focused approach to recovery.
Methadone and Suboxone are both used as “opioid replacement” medications as part of a harm-reduction, rather than recovery-focused approach. It is still possible to abuse opioids while taking methadone or Suboxone.
What are the Disadvantages of Vivitrol?
There are a few areas of concerns with Vivitrol, but these are easily addressed.
- The need for opioid detoxification – Lowered opioid tolerance means prospective Vivitrol patient must be completely opioid-free for up to two weeks before they can begin receiving injections. Unfortunately, this usually means that MAT involving Vivitrol must be delayed.
Suboxone and methadone patients can start MAT immediately, without undergoing an opioid detox.
So what’s the solution?
The need to detox is not unusual. Most addiction specialists recommend that their clients check into a detox program before entering treatment. The staff at a professional, medically-supervised detox facility can help make the transition of withdrawal as safe as comfortable and as possible.
- It is still possible to overdose on opioids – Overdosing while on Vivitrol takes effort, but it is still possible. If a Vivitrol patient tries to abuse opioids, not only will they NOT get high, they will also immediately go into acute withdrawal.
But if they take more opioids in a desperate attempt to overcome withdrawal and Vivitrol’s opioid-blocking the effects, they CAN overdose.
So what’s the solution?
As mentioned earlier, when Vivitrol is used in combination with counseling, successful recovery is very likely. Anyone find it hard to stay abstinent while receiving Vivitrol should let their counselor know.
- Pain management will change – Again, because Vivitrol lowers opioid tolerance, patients must find new ways to deal with pain.
So what’s the solution?
According to the most-recent prescribing guidelines, opioids should already be the “last resort” for pain management. Doctors have been advised to try other methods first – exercise, weight loss, massage, meditation, etc.
- Possibility of liver damage – Vivitrol is not recommended for patients who are already having liver problems – disease or damage from chronic substance abuse, for example.
So what’s the solution?
You should ALWAYS discuss your personal health history with your physician before starting ANY new medication. Your doctor can help you decide if Vivitrol is the right choice.
- Vivitrol is expensive – A month’s supply of Suboxone cost about $100. A once-monthly injection of Vivitrol, on the other hand, can cost up to $1200.
So what’s the solution?
Because of the potential long-term savings, many private insurers cover Vivitrol injections.
Vivitrol – What’s the Bottom Line?
Because of its wider availability and the greater number of possible applications, Vivitrol may potentially help many more struggling substance abusers than methadone, or Suboxone. And, because the treatment goal with Vivitrol is total abstinence and sobriety, rather than the “harm reduction” goal of methadone and Suboxone, it may start to become more accepted and offered by drug rehab programs. Because IN THE END, is exactly what is needed to help the estimated 2.6 MILLION opioid-dependent people in America – more treatment options. Dr. John Rotrosen, a Psychiatry Professor with New York University’s School of Medicine says, “The main finding in my view is the relatively equivalent safety and effectiveness of these two medications…This gives patients the freedom to choose a treatment approach that best suits their lifestyle, goals and wishes.”