Vivitrol isn’t the ‘perfect’ opioid addiction treatment yet…but it’s close.
It seems like we, as a society, are eternally on the hunt for miracle cures to entrenched problems – addiction to alcohol and other drugs, unhealthy eating, gambling addiction, to name a few. We want one tiny pill that will magically render us whole again, free of cravings, health fully restored.
Last week, the Support Systems Homes Executive Director and I attended the California Department of Health Care Services Substance Use Disorder Statewide Conference in Southern California. We had the opportunity to network and hear about trends and advances in the field. One thing that was discussed – and praised quite a bit – was Vivitrol, a medication approved by the FDA in 2010 to help prevent alcohol and opioid misuse.
We didn’t hear any cons to using it, actually. So I decided to do some research once we returned home.
Vivitrol is a New Form of Naltrexone, a Stalwart of Drug Treatment Programs
Naltrexone HCL is a longtime treatment option for alcohol and opioid use disorders. It’s taken in one daily-dose pill during treatment programs.
Naltrexone works to prevent the effects of opiates (euphoria, pain relief, etc.), and decreases the desire to take them. This puts it into a class of drugs called “opiate antagonists.” But you can use it in alcohol treatment as well; it also decreases the urge to drink alcohol. In all cases, taking Naltrexone works best when used as part of a comprehensive treatment program that supports lifestyle changes.
Vivitrol is extended-release naltrexone. Instead of a pill though, it comes in the form of a once-a-month shot. Patients must have completed opioid detox, if relevant, and cannot drink actively before starting Vivitrol.
How the Naltrexone Medication Helps with Addiction Recovery
While drugs such as buprenorphine and methadone reduce cravings and withdrawal symptoms, you must take naltrexone AFTER withdrawal is complete. Why? Because it blocks the effects of opioids.
If taken too early, it will catapult the patient into withdrawal…suddenly and severely. Thus, a client needs to have a gap of 1 week or more after starting treatment. Otherwise, research indicates that the possibility of returning to drug use increases.
In fact, the early treatment dropout rate in clients using naltrexone is much higher than in those using buprenorphine. According to the NIDA study:
- Patients had a more difficult time getting onto naltrexone than buprenorphine.
- 6% of the buprenorphine group failed to start on the treatment.
- 28% percent of the naltrexone group initially dropped out.
However, once you overcome the initial hurdle, the rates are similar on both medications.
The once-a-month injection of Vivitrol sounds pretty miraculous. You don’t have to remember to take a pill daily. It acts as a deterrent to substance use, mentally as well as physically blocking the effects. It blends well with overall treatment (including counseling and other supports). It even removes the inherent risks with the use of methadone or buprenorphine of developing a secondary addiction.
Close to a Cure-All, But Not Quite: Vivitrol’s Bumps in the Road
So, what could possibly go wrong with this long-lasting, non-narcotic medication? Well, finances, for one thing. “Miracles” are costly in our society. You can pay quite a lot for the Vivitrol shot, depending on insurance coverage and other factors.
As of early 2018, if you’re covered under the Affordable Care Act, the Vivitrol co-pay is $500 per injection. With private insurance, the co-pay can go above $1,000 per injection.
The manufacturer of Vivitrol, Alkermes, does offer a co-pay assistance program to help. But even with help, the cost becomes a huge barrier for those trying to stabilize their lives.
Other issues exist as well:
- The manufacturer has experienced negative feedback from SUD experts not only due to the cost of Vivitrol, but also because of its “aggressive” promotion of Vivitrol before there was much evidence of effectiveness.
- Addicts are adept at finding “workarounds” that allow them to use their drug of choice while seemingly on the road to recovery. This is why it’s so important to combine the use of Vivitrol with treatment supports.
- Because this medication can heighten the individual’s sensitivity to opioids, it increases the chances of overdose if a) the client relapses, returning to their “typical dose,” or b) the client takes a large amount of opioids in order to “overcome” Vivitrol’s opioid-blocking effects.
Vivitrol is the newest tool in a toolbox of medications used in substance abuse disorder. It shows plenty of promise, both in effectiveness and in lasting help. There are caveats, which make doing your research and talking with a clinician vital. If Vivitrol can help your treatment process, it’s worth a serious look.