Fortunately, there is a once-per-month treatment, Vivitrol, that can help recovering opioid addicts feel fewer cravings for heroin or prescription pain narcotics. With the opioid epidemic in the United States, Vivitrol is an advantage that can help millions of people get their lives back.
Two million Americans abuse or are dependent on street and pharmaceutical opioids, with hundreds dying daily from overdoses. This has driven the need to intensify rehabilitation and treatment programs and to help addicts recover. Considering that these programs often involve long-term or even lifelong medication, the pharmaceuticals need to be effective and tolerable. This is where Vivitrol comes in. It is a monthly injectable drug used for long-term treatment of opioid addiction, and it offers promising results.
What is Vivitrol?
Vivitrol is a drug used for the treatment of opioid and alcohol addiction. It is non-addictive and given as a monthly injection. It is used in rehabilitation programs after detoxification, and often given alongside counseling. It is currently the most promising drug in opioid rehabilitation programs, and most likely the future of opioid rehabilitation.
The history of Vivitrol
The active drug in Vivitrol, that is naltrexone, was discovered way back in 1963. But it was not until the 80s when the drug was approved for treatment of opioid addiction and later alcohol dependence. The drug was however available as an oral pill, which raised issues on compliance. Injectable forms had a very short duration of action and were therefore unfit for rehabilitation programs.
Alkermes saw the need to have an injectibles formulation of the drug that wouldn’t require regular dosing. That led to the development of Vivitrol, a depot formulation of naltrexone. It was approved by FDA for treatment of alcohol dependence in 2006, and for the treatment of opioid addiction in 2010.
How does Vivitrol work?
Vivitrol is a depot injection formulation of the drug naltrexone. It is an opioid antagonist. It binds to opioid receptors in the brain, preventing other opioids, both endogenous and exogenous from acting on these receptors. By doing this, your body is shielded from the effects of opioids.
Vivitrol is non-addictive
The use of Vivitrol employs a different approach to management of opioid dependence. Classic treatments for dependence involve replacement therapy in which a new opioid s introduced in place of the addictive drug. An example is the methadone program in which methadone is given to heroin addicts. The disadvantage of this is that methadone, buprenorphine, and other substitute opioids are still addictive.
Vivitrol is an exception to these. Its working approach is to antagonize, and not to replace the effect of the addictive substance. It is like the polar opposite of opioids. This way, it enables the recovering addicts to achieve an opioid-free state, reduce their craving for drugs and ultimately abstain from indulgence.
How is Vivitrol given?
Vivitrol is a depot formulation administered as an intramuscular injection. It is given as a single dose containing 280mg of Naltrexone. The injection is given to the gluteal region. The formulation is then slowly released from the injection site over the next 30 days. It is therefore administered as a monthly injection.
The benefit of this preparation is that it enhances compliance. A lot of people are not comfortable with taking pills on a daily basis or regularly visiting a clinic for injections. Vivitrol makes it possible for them to be compliant with the treatment program by simply coming for a monthly injection.
So what does Vivitrol have to offer?
There are several benefits that Vivitrol contribute to the rehabilitation program. Below is a summary of the benefits of Vivitrol over other rehabilitation treatments:
Achieve opioid-free state. Vivitrol enables users to be free of opioids in the shortest time possible. This is important for people with legal or job requirements that make it hard for them to take methadone and other opioids.
·Improved compliance. One month injection is an easier option compared to daily pills
·Reduced craving for opioids, and reduced risk for relapse
·No side effects of opioid treatment such as sedation, mild euphoria, and hallucinations.
Where does Vivitrol fit into the rehab program?
Vivitrol is one of the last treatments in a rehabilitation program. It is strictly used in the setting of approved rehabilitation programs. Patients first have to undergo detoxification. This may involve management of withdrawal in an inpatient set up. During this period, replacement drugs such as methadone may be used to achieve detoxification with minimal withdrawal symptoms. The patients receive counseling and psychological support throughout this process.
Vivitrol is used in outpatient management after completion of an inpatient rehabilitation program. It is introduced when complete detoxification has been achieved. At this point, the patient has been tapered off of all opioids, has received enough counseling and is ready to go home.
Vivitrol is then given monthly, alongside with scheduled counseling. It is used in comprehensive rehabilitation programs that employ a dual approach: the counseling to help patients deal with the psychological aspect of addiction and Vivitrol to work on the brain to reduce its cravings and dependence on opioids.
The duration of treatment using Vivitrol is variable. It depends on the patient’s response to the rehabilitation program, his/her level of dependence, and willpower to quit using. It is, however, a long-term treatment plan, with most patients being on the drug for months to years.
Vivitrol’s possible complications
Just like any other drug, Vivitrol is not perfect. There are some downsides to the use of this treatment. It is however very safe compared to other treatment options, and only a few of the side effects are experienced. The possible adverse effects include:
– Injection site reactions – these are mild irritations that usually occur at the time of administration. Pain, swelling, reddening, pruritus and bruising may occur at this site.
– Precipitation of opioid withdrawal – this occurs if the drug is taken by a patient who is still opioid dependent. The antagonistic effects of the drug drastically reduce the effect of opioids, thus causing withdrawal
– Hepatotoxicity – the drug has been reported to cause liver damage. Derangement in liver function tests and drug-induced hepatitis can occur.
– Depression – the drug antagonizes even endogenous opioids which are the feel-good hormones. Some patients can, therefore, get depressed and even have suicidal thoughts.
– Hypersensitivity reactions – there’s a possibility of being allergic to the drug. Such people experience allergic reactions, including anaphylaxis.
– Eosinophilic pneumonia – patients may experience respiratory symptoms after administration of Vivitrol.
– Nasopharyngitis – experiencing flu-like symptoms.
– Vulnerability to opioid overdose – this only occurs is patients attempt to take opioids while on treatment. Due to the blockade effect of Vivitrol, patients will need to take higher doses of heroin or other opioids in order to get high. This can easily lead to an overdose, especially in the 3rd or 4th week of treatment when the drug is wearing off.
The above complications, however, occur in a very small percentage of the population.
Who qualifies to use Vivitrol?
Vivitrol is generally used to manage alcohol dependence and prevent opioid addiction relapse after detoxification. Not everyone who needs this treatment will get the prescription. There are certain indications and contraindications. Below are some of the contraindications that may force patients to miss out on this treatment:
– Patients on opioid analgesics – this is because Vivitrol will antagonize its effects
– Those in acute opioid withdrawal – Vivitrol will only make it worse
– Patients who are not fully detoxified – detoxification is a necessary prior to initiation of Vivitrol treatment. Patients need to have an opioid-free interval of at least 7days before starting on Vivitrol. As for those on methadone or buprenorphine, they need to be fully tapered off two weeks prior to the start of treatment.
– Hypersensitivity to naltrexone
– Patients with liver disorders – Vivitrol may exacerbate the condition.
Comparison of Vivitrol with other treatments
Prior to the introduction of Vivitrol, methadone, and buprenorphine were the mainstay treatments. These are substitution therapies that require patients to take these opioids instead of heroin and other drugs they were addicted to. Though safer than heroin and other narcotics, these opioids still have the side effect profile of opioids: addiction, sedation, hallucination, and constipation among others. Vivitrol, on the other hand, is free of all this.
Short-acting formulations of naltrexone such as Depade and Revia were the first drugs to offer opioid-free treatment. These are however faced with a lot of challenges in terms of compliance. They require daily dosing, something that most patients are not up for.
Vivitrol vs suboxone
Suboxone is a drug widely used for the treatment of opioid addiction. It contains naloxone, a mild opioid agonist. The drug has been the mainstay therapy for addiction for several years. The entry of Vivitrol into this space has created a debate on which is the better treatment method.
Lancet, funded by NIDA clinical trials network, carried out a research [hyperlink: https://goo.gl/hMJnwB] to compare the two drugs. The findings revealed that both drugs are equally safe and effective in the management of heroin addiction and other forms of opioid abuse. However, the fact that Vivitrol is free of the opioid side effects cannot be discounted.
Price is the only major difference between the two drugs. Suboxone is significantly cheaper than Vivitrol. This is the major reason why Vivitrol has not been adopted by many physicians and patients.
Vivitrol in American Jails and Prisons
American prisons are home to thousands of addicts. 65% of prisoners in state prisons are addicts, and most of them do not get treatment. [hyperlink: https://goo.gl/sxHRnP]. To help intervene in this situation, Vivitrol was introduced as a treatment option for inmates coping with opioid addiction.
The Vivitrol prison program targets inmates who have served their sentence and are being released back to the world. These inmates are at a great risk of falling back into addiction because they once again have access to street drugs. The program offers them to get on Vivitrol monthly injections as a way of staying clean. This way, they have a reduced urge to indulge in drug use. Also, should they decide to use heroin or other opioids, they wouldn’t get high because of the blocking effects of Vivitrol.
The program has been picked up by various prisons in 28 different states. It has been successful, with inmates who stick to the plan for up to six months staying opioid-free 90% of the time [hyperlink: https://goo.gl/4ikzMo]. This has facilitated their acceptance and integration back into the society.
Trump’s Opioid Plan
This is a plan designed by President Trump’s government to combat the ongoing opioid crisis. It focuses on reducing the ease of access to both street and prescribed opioids. Other than that, the project also aims to provide medical-assisted treatment, to be specific Vivitrol, to prisoners dealing with opioid addiction.
The Vivitrol-aspect of the program involves the government paying for the inmates’ first shot of Vivitrol upon release. It aims to help prisoners maintain a drug-free life after release, and facilitate their integration to the society. This has however sparked controversy with several groups arguing that it is an unwise way to spend taxpayers money. However, such a project could help rehabilitate a significant percentage of the country’s drug addicts.
The remaining aspects pillars of Trump’s opioid plan have still stirred a lot of outroar. The first part involves tightening the regulations governing prescription of painkillers. This aims to reduce the ease of access to pharmaceutical opioids which is currently fueling addiction.
The legal aspect of this plan has drawn the most attention. Trump plans to tighten the laws on drug trafficking and possession in a bid to take down the criminal associations that supply street opioids. If passed, the law will raise the minimum sentencing times for drug trafficking, and even make death penalty an option. A lot of activists have already risen against this move.
In conclusion, Vivitrol is a drug that is revolutionizing the management of opioid addiction. It offers recovering patients a simple method of avoiding replapse and achieving it in an opioid-free state. Unlike other treatments that require daily medication, Vivitrol requires only a single shot every month. It is also free of all the sedative of opioids and has very few side effects. it is therefore right to say that Vivitrol is indeed the future of opioid addiction treatment.