Heroin and other opiates – and even more generally, opioids – are drugs that are seductively attractive to users due to the euphoria they can produce through the reward regions of the brain.
While heroin is an illicit drug, opioid medications are often prescribed to treat severe or chronic pain. Whether these products are ingested, smoked, snorted or injected, they tend to give the user a wonderful feeling – sometimes referred to as a “rush” or “high.” Allured by its effects, some people seek to regain this carefree feeling…again and again. Abuse can turn to dependence, and dependence to addiction.
How Did Vivitrol Come to Be Used for Treating Opiate Addiction?
For years, the primary medication options for treating abuse of opiates and other opioids were methadone (known by the trade names Dolophine and Methadose) or buprenorphine (alias Subutex and Suboxone). Meanwhile, Vivitrol has been successfully used to treat alcohol dependence since 2006.
However, in 2010, the FDA approved Vivitrol – trade name for an extended-release formula of naltrexone –for treating opioid dependence. (Alkermes, Depade and Revia are other trade names for this product.)
How Does Vivitrol Work?
Vivitrol (naltrexone) is an “opioid receptor antagonist,” which means that it blocks the opioid receptor in the brain. In doing so, it takes away the reward of getting high on opioids. This makes it an excellent pharmacotherapy choice for preventing relapse (falling back into problem drug use) following detoxification treatment. Some heroin users claim that Vivitrol totally takes away the desire for opiates.
Sure…It’s Easier to Take, But How Effective Is Vivitrol?
For reasons that are not yet clear to experts, Vivitrol seems to greatly reduce cravings for narcotics. Test patients have reported a 50% average amount of reduction in subjective craving – compared with no change in craving for subjects receiving placebo. Many heroin users claim it totally takes the cravings away. Furthermore, after six monthly shots, 70% of those who received this drug had not gone back to using narcotics – double the rate of patients who had received a placebo. Other test data on long-acting naltrexone shows 82% of patients as opioid-free at 12 months following detox– compared to 58% for the “oral” naltrexone group and 52% for the control group.
Why Is Vivitrol’s Form of Administration so Integral to Its Success?
The maintenance of consistent blood levels of naltrexone may be an important factor in the success of sustained-release formulas over daily doses of naltrexone. Compliance with the treatment program has been a big reason that other means of administering naltrexone have resulted in much poorer outcomes. In the long-acting form, discontinuation of treatment during the dosage interval is greatly inhibited.
However, the need for more research and reliable, long-term data remains; published data is sparse.4
What Concerns Currently Exist with Using Vivitrol?
Vivitrol’s great success has been met with some reservations regarding:
- Hepatotoxicity – Treatment with long-acting naltrexone should be monitored for possible damage to the liver.
- Sensitivity to Opioids -Consistent dosing of Vivitrol can lead to increased sensitivity to opioids in an individual previously tolerant to larger opioid doses.
- Risk of Opioid Overdose – Patients should be made aware of the increased risk of overdose with administration of opioids during and immediately after discontinuation of naltrexone – especially in the first two weeks out of treatment. Such overdoses can lead to injury, coma or even death.3
Common adverse reactions related to long-acting naltrexone injections are:
- injection site reactions
- elevated liver enzymes
- depressed mood
Patients should be assessed individually in regard to their health status, concomitant medications, hepatitis status and risks and benefits profile when considering whether to start treatment with Vivitrol.3
Caution: Prescription Narcotics Can Lead to Heroin Use
Prescription opioid abuse is not only costly in economic terms (non-medical misuse of opioid pain relievers causes more than $70 billion annually in health-care costs) but may be partly responsible for the steady upward trend in poisoning mortality as well.
While prescription painkiller abuse greatly surpasses the illegal use of heroin, research shows that 80% of new heroin users started out by abusing doctor-prescribed opioids. Interestingly, growing evidence suggests that abusers of prescription opioids are shifting to heroin as prescription drugs become less available or harder to abuse.
Medications Are Only Part of a Complete Treatment Program
Medication-assisted treatment (MAT) will be most effective when offered within the larger context of a high-quality delivery system that addresses opioid addiction not only with medication, but also with behavioral interventions to support treatment participation and progress.5
Getting Help for Addiction to Prescription or “Street” Drugs
If you or someone you love is in need of drug detox and rehab, we urge you to call The Canyon at our toll-free number. We are there to take your call 24-hours-a-day, listen to your concerns and answer any questions you have about treatment, financing or insurance. We can also offer some treatment options for you to think about. Comprehensive, evidence-based treatment of drug addictions and mental disorders. It’s what we do, and we do it very well…with concern for each and every individual that we serve.
1“The Facts About Naltrexone for Treatment of Opioid Addiction”, Substance Abuse and Mental Health Services Administration, https://store.samhsa.gov/shin/content/SMA12-4444/SMA12-4444.pdf , (2012).
2 “Messages from the Director”, National Institute on Drug Abuse, https://www.drugabuse.gov/about-nida/directors-page/messages-director/2010/10/important-treatment-advances-addiction-to-heroin-other-opiates, (October 2010).
3“Long-Acting Injectable Naltrexone for the Management of Patients with Opioid Dependence”, National Center for Biotechnology Information, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411517/, (February 6, 2011).
4“Improving Clinical Outcomes for Naltrexone as a Management of Problem Alcohol Use”, National Center for Biotechnology Information, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853523/, (November 2013).
5 Volkow, Nora D., Director of National Institute on Drug Abuse (NIDA), “Prescription Opioid and Heroin Abuse”, NIDA, https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/prescription-opioid-heroin-abuse, (April 29, 2014).