Vivitrol: An Underused Medicine in the Opioid Epidemic
As many people across the U.S. continue to struggle with opioid addiction (heroin and prescription pain pills), several lifesaving medicines remain out of reach because of their cost or availability. In 2010, the U.S. Food and Drug Administration approved Vivitrol – a once-per-month injection that blocks the effects of opioids and reduces cravings. Vivitrol is an injectable form of the medication naltrexone (brand name Revia), which is taken orally several times per week, and has been used to treat opioid addiction for over 20 years.
The positives of Vivitrol
There are a number of positives to Vivitrol. These include the following factors:
- Non-narcotic. Vivitrol is an opioid antagonist, a kind of medication that blocks drugs like heroin, OxyContin, and Vicodin from activating the brain’s receptors, without being an opioid itself. There is no risk for physical dependence on the medicine, and patients will not experience a “high” from opioids if they use them up to four weeks after receiving their last injection of Vivitrol
- Long-lasting. Unlike the oral medications for opioid addiction that must be taken every day (methadone), or several days per week (naltrexone, Suboxone or buprenorphine), one injection of Vivitrol lasts for about one month
- Adherence. As a monthly injection, it requires significantly less commitment from patients to attend treatment appointments or medication pick-ups, and it eliminates the problem of missing or forgetting to take medications for one month. However, it does require returning to the doctor for monthly injections for at least 6 months, which can be a challenge for some patients
- Lowers the risk of overdose. Vivitrol blocks the opioid receptors in the brain, making it nearly impossible for those on Vivitrol to “get high,” should they use opioids. Though the opioids remain toxic, this effect discourages patients from using in large enough quantities to cause an overdose, and also deters individuals from continuously relapsing
- A better option for some patients. Vivitrol may be a better choice than methadone or buprenorphine (Suboxone) for some patients, including those who have not been addicted to opioids for very long, have not experienced multiple relapses following treatment, or who haven’t used opioids in a long time (e.g., those transitioning from a rehabilitation program or prison where they have already been through withdrawal or detoxification)
The negatives of Vivitrol
Like most treatments, there are some negatives to Vivitrol, which include:
- The mandatory withdrawal period. Opioid addicted individuals must refrain from opioid use for seven to 10 days before receiving Vivitrol, or they will experience withdrawal symptoms. This withdrawal can be severe and potentially discourage individuals from using Vivitrol
- Cost. Until recently, Vivitrol has been prohibitively expensive and not covered well by insurance – it costs around $1,000 a shot (with insurance coverage, the co-pay is typically $25-50 dollars). This has significantly limited its availability and access. There are some signs that his may be changing, as more private insurance companies are covering Vivitrol. Medicaid is also increasingly supportive of its reimbursement. As of 2013, 41 states had Medicaid programs that covered Vivitrol. Alkermes, the company that produces Vivitrol, is also attempting to make the drug more affordable with rebates through its system called Touchpoints
- Patient preference. Some patients are hesitant about using Vivitrol. Concerns include discomfort with the shot, the inability to receive pain management while on the medication (as Vivitrol blocks all opioid receptors in the brain), and a preference for opioid maintenance therapies
- Efficacy. Research on Vivitrol has not conclusively shown its effectiveness to be greater than other approaches over a long period of time. Though it is a relatively new treatment, long-term studies still need to be conducted before Vivitrol can be conclusively deemed a more effective option than opioid maintenance therapies
What the research shows
During a 24 week study, participants who used Vivitrol were abstinent from opioid use 90 percent of the time. Researchers reported even higher rates of total abstinence following the initial four weeks of the study. Vivitrol has similarly demonstrated its effectiveness with populations that have high rates of overdose death, like opioid dependent individuals recently released from prison.
Despite its effectiveness, many patients and families don’t know that Vivitrol is even an option for the treatment of opioid addiction. It can also be hard to find a doctor who will prescribe it. More work does need to be done to promote the use of Vivitrol and improve its access and affordability. It could very well become another important tool in ending the heroin epidemic.
Max Dorfman is a Science Writer at Center on Addiction