Is Vivitrol Therapy Right for Me?
Vivitrol isn’t the only drug used in the treatment of opioid dependence. However, two of the other pharmaceutical agents widely used in the field of medication-assisted treatment are themselves opioid agonist drugs, used for both induction/stabilization and maintenance treatment. Vivitrol is a nonaddictive alternative and/or supplement to opioid agonist therapy (i.e., methadone and buprenorphine) and a valuable adjunct to many motivated individuals’ opioid addiction recovery process.
How Does Vivitrol Work?
Vivitrol is a branded formulation of extended-release naltrexone, an opioid antagonist. Unlike buprenorphine and methadone, naltrexone doesn’t work by stimulating the opioid receptors in the brain. In fact, the opioid antagonist blocks the effects of opioid drugs at the receptor level to decrease the reinforcing reward of continued use of drugs such as heroin and prescription narcotic painkillers. In such a manner, relapse and continued opioid misuse is discouraged. There is some evidence that extended-release naltrexone therapy also results in a reduction of subjective opioid cravings as well.
Vivitrol has been approved by the U.S. Food and Drug Administration for alcohol dependence as well. The exact mechanism of action behind how naltrexone improves recovery from alcohol dependence isn’t entirely understood, but it may involve a diminishing of an opioid-mediated response or anticipation to alcohol cues. Alcohol directly influences the function of GABA receptors in the brain, but its rewarding properties may be at least partially mediated by endorphin activity at mu and delta opioid receptors there; therefore, naltrexone can interfere with how alcohol affects the brain’s opioid receptors. It’s said to reduce a person’s urge to drink to help with abstinence maintenance. If the person should relapse and resume drinking behavior, naltrexone could diminish the reinforcing properties of the alcohol that is consumed, which could ultimately curb the desire to drink more.
A person suffering from addiction must undergo an initial medical detoxification period before they are able to start taking Vivitrol. The medication should not be taken until seven days since last opioid use; if it is taken sooner, it can prompt opioid withdrawal symptoms. It begins working within 30 minutes of administration.
While Vivitrol can enhance recovery, it is not effective addiction treatment on its own. It should be used alongside behavioral therapy to promote a solid recovery.
Vivitrol and the Fight against Addiction
Vivitrol may help patients to better focus on the behavioral therapeutic aspects of rehabilitation and recovery. With diminished cravings and a decreased risk of relapse, individuals may be better able to focus on recovery, resulting in better success rates.
According to the National Institute on Drug Abuse, past estimates placed the number of people, worldwide, who were abusing opioids at between 26.4 million and 36 million. In the United States alone, it’s estimated that 2.1 million suffered from a prescription opioid substance use disorder in 2012. Heroin addiction affected an estimated 467,000 individuals.
Without treatment, those who struggle with painkiller or other opioid addiction are at risk for overdose—a growing concern, given the increasing prevalence of heroin and other illicit drug supplies being mixed with fentanyl or other potent, deadly opioid analogues. In 2015 alone, more than 20,000 people overdosed on prescription painkillers while nearly 13,000 overdosed on heroin.
What Are the Positives of Vivitrol?
There are many positives to using Vivitrol in recovery, such as its ability to block the effects of opioids and diminish some of the reward of drinking alcohol if a person does relapse. When used by people highly motivated in their treatment, such effects may lessen the chances for relapse, especially in the early stages of recovery.
Additionally, Vivitrol may play a role in preventing cravings that might otherwise lead a person to relapse after the initial opioid detoxification process. Though many people are able to resume their recovery trajectory after a relapse, in some instances, an early relapse can lead to a person giving up the recovery the process altogether.
Studies have indicated that the use of an extended-release naltrexone such as Vivitrol may be comparably effective for the treatment of opioid use disorder as a combination of buprenorphine and naloxone (e.g., Suboxone)—an encouraging finding, especially for people who do not wish to remain on opioid agonist maintenance treatment indefinitely.
A related benefit for those on Vivitrol monotherapy would be there is no risk of withdrawal when discontinuing the drug like they do when opioid agonist maintenance is a factor. Consequently, naltrexone therapy doesn’t require a drug taper when discontinuing either. Because the drug is long-lasting, Vivitrol is a convenient treatment tool for people in recovery. It doesn’t require a person to remember to take a pill each day, nor does it require a person to commute to a clinic or treatment facility numerous times per week.
What Are the Negatives of Vivitrol?
Some individuals who take Vivitrol may experience side effects from the drug. These include:
One study conducted by DuPont Pharma on 570 participants who used Vivitrol for alcoholism revealed that nausea was the most common side effect. In fact, 10 percent of participants experienced nausea. Headaches and depression were the next most common side effects of Vivitrol with 7 percent of participants experiencing headaches and 5-7 percent experiencing depression, as noted by the National Institute on Alcohol Abuse and Alcoholism.
Another potential drawback of naltrexone therapy is that it should only be initiated in people who have already withdrawn from both opioids and alcohol. In the case of some longer-acting opioids, this could take as long as 10 days for the acute withdrawal period to resolve prior to the start of naltrexone treatment.
As Vivitrol is administered via intramuscular injection, it necessitates a slightly invasive procedure, although it only requires re-administration every 4 weeks (in contrast to a daily oral medication regimen). Another consequence of such an extended-release application is that any medical situation that might otherwise benefit from opioid use (post-surgical analgesia, pre-surgical induction, emergent injuries) could present some issues in alternately managing.
Lastly, the prolonged opioid receptor blockade achieved through the use of Vivitrol will be accompanied by a significant lowering of opioid tolerance. As a result, relapse associated overdose risks could be elevated in someone who has recently discontinued naltrexone therapy and should be carefully considered as part of a supervised continuum of care for such individuals.
Who Shouldn’t Use Vivitrol?
Vivitrol isn’t for everyone who has a drug or alcohol addiction. As mentioned, those who might require opioid-based medication for pain relief may need to talk to their doctor about switching medications or may not be able to take the medication. Those who have kidney or liver problems shouldn’t take Vivitrol, especially those with liver failure or acute hepatitis.
Those who are evaluated to be relatively less motivated for recovery may not be ideal candidates for naltrexone therapy any attempts overcome the opioid receptor blockade effects could result in a serious injury, coma, or death. Additionally, people previously on opioid agonist maintenance must not have used methadone or buprenorphine for at least a week prior to starting Vivitrol (or whatever length of time is required for a complete, gradual abatement of physical withdrawal symptoms).
Pregnant women shouldn’t take naltrexone. A pregnant woman will need to stop taking the drug and be monitored carefully throughout pregnancy, and the baby will need to be monitored closely after delivery if the mother gets pregnant while taking Vivitrol. Those with bleeding problems, such as low platelets or hemophilia, may not be able to take Vivitrol.
What Does a Doctor Need to Know before Prescribing Vivitrol?
A doctor must know when the person last took opioids. It’s also vital for the doctor to know any medications the person is taking to prevent any interactions with Vivitrol. A person should notify the prescribing doctor of any kidney, liver, or bleeding problems. As soon a woman misses her period while taking naltrexone, she should inform a physician.
If a person begins to experience any of the following acute opioid withdrawal symptoms when taking naltrexone, treatment will need to be stopped and resumed at a later time:
- Teary eyes
- Runny nose
- Hot or cold flashes
- Stomach cramps
- Muscle aches
- Muscle twitches
Those who use Vivitrol should carry a card to indicate they use the medication in the event of a medical emergency.
What Does the Research Say about Vivitrol?
A double-blind clinical study showed positive results from individuals who were opioid-dependent. The six-month, randomized study compared two groups: one who received a placebo along with counseling and the other who received Vivitrol and counseling. At the end of the study, the people who took Vivitrol had an average of 90 percent opioid-free weeks while the placebo group only had an average of 35 percent opioid-free weeks. The group who took Vivitrol also reported a 55-percent decrease in self-reported cravings. In contrast to the placebo group, the Vivitrol group was 17 times less likely to have a serious relapse that resulted in physical dependence. On average, the group who took the opioid antagonist remained in treatment longer. In fact, individuals in this group stayed in treatment for an average of more than 168 days. In comparison, those in the placebo group stayed in treatment an average of 96 days.
The results of a placebo-controlled, double-blind, randomized trial of 250 opioid dependent outpatient subjects showed that more individuals in the experimental Vivitrol group had complete abstinence between weeks five and 24 than the placebo group. In fact, 36 percent of people in the Vivitrol group achieved total abstinence during those weeks while only 23 percent of people who received the placebo achieved total abstinence.
Research reviews have indicated that naltrexone therapy could be highly beneficial in parts of the world where opioid agonist “substitution” treatment is prohibited or otherwise unavailable. The country doesn’t provide citizens with the option of maintenance drugs like methadone or buprenorphine. A related finding is that naltrexone therapy can be effective in those highly motivated to recover and compliant with a prescribed treatment regimen.
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