WHAT IS VIVITROL?

“…VIVITROL IS A VALUABLE ADDITION TO THE RECOVERY TOOLBOX, ALONG WITH METHADONE AND BUPRENORPHINE…MEDICAL RESEARCH UNEQUIVOCALLY SHOWS THAT MOST INDIVIDUALS ADDICTED TO OPIATES REQUIRE SOME FORM OF MEDICATION TO RECOVER FROM THEIR ADDICTION, A CHRONIC BRAIN DISEASE…VIVITROL, LIKE ANY OTHER MEDICATION FOR OPIOID DEPENDENCE, MUST BE ACCOMPANIED BY A FIRM COMMITMENT TO RECOVERY, INCLUDING SUBSTANCE ABUSE COUNSELING, OUTPATIENT PROGRAMS AND SUPPORT SYSTEMS.

–Dr. Mark Publicker, President, Northeast Society of Addiction Medicine as reported by the Bangor Daily News August 27, 2014 in article “Once-a-month shot that blocks high from opiates making inroads in Maine.”

Most people are unfamiliar with the injectable medication Vivitrol and how it used in the treatment of opiate addiction. While there is no generic available for Vivitrol, there are oral medications that contain the same ingredient. The oral version is available as the generic naltrexone and may also be known as ReVia.

The following questions and answers are provided to educate, dispel myths and familiarize people with Vivitrol and its use in opiate treatment. As always, if you have any additional questions or would like to share your comments you can always contact Center for Behavioral Health or any of our individual Treatment Locations.

WHAT IS OPIOID DEPENDENCE?

Opioids, such as some prescription pain medications or heroin, attach to the opioid receptors in the brain, which stimulate the release of dopamine and produce pleasurable feelings. When the opioid eventually detaches from the receptors, people experience withdrawal and cravings and have a strong desire to repeat the experience. The need to satisfy cravings or avoid withdrawal can be so intense that people who want to stop taking opioids find this difficult to do. Or, they may find themselves doing things they would not ordinarily do in order to obtain more of the drug they crave. For this reason, even though opioid dependence is a medical condition and not a moral failing, it can drive behavior.

Drug use often begins as a choice, but frequent use can cause the brain cells to change the way they work. The brain is re-set to think that the drug is necessary for survival. Researchers have discovered that many drugs, including opioids, cause long-term changes in the brain. These changes can cause people to have cravings years after they stop taking drugs. Research has shown that addiction is a chronic, relapsing brain disease, but treatment can help achieve recovery.

WHAT IS VIVITROL?

Vivitrol is one of the newest medications available and can treat both opiate and alcohol addiction. It blocks other opioids from acting on the receptors in the brain and can also help ease drug cravings. By blocking the effects of other opioids it takes away the pleasurable effect, which can help with preventing relapse. Although it is not fully understood as to why an opioid antagonist works in treating alcoholism, it is believed that Vivitrol blocks the pleasurable effects of alcohol by blocking the release of endorphins caused by alcohol. This treatment can help you stop misusing opioids and alcohol and, when combined with counseling, can help you rebuild your life.

WHAT IS AN OPIOID ANTAGONIST?

An antagonist is a non-opioid that binds to opioid receptors in the brain. The way different opioids work can be explained using a lock and key example. Receptors are like a lock to a door. Only the right key will fit the lock, and only opioid-like drugs fit opioid receptors. With a full opioid agonist such as oxycodone, hydrocodone, morphine, or heroin, the key fits the lock, opens the door wide, and produces full opioid effects (the feeling of euphoria, or being high, as well as the side effects). With an antagonist, such as Vivitrol, the key fits the lock but does not open the door at all, it simply blocks other keys from fitting the lock.

HOW EFFECTIVE IS VIVITROL TREATMENT?

Studies have shown that opioid-dependent patients who received counseling and Vivitrol had significantly more days of complete abstinence, stayed in treatment longer, reported less craving, and were less likely to relapse to physical dependence. Complete abstinence was defined as having a negative urine drug test for opioids and no self-reported opioid use. Craving was measured by self-reported “need for opioids”.

In a study of alcohol-dependent patients participating in counseling plus Vivitrol, patients had significantly fewer heavy drinking days (defined as a self-report of 5 or more drinks on a given day for males and 4 or more drinks for females). A small group of alcohol-dependent patients who completely stopped drinking one week prior to their first dose of Vivitrol and had counseling had significantly fewer drinking days and more success maintaining complete abstinence.

HOW DOES VIVITROL WORK?

Vivitrol is an opiate antagonist with a series of actions that make it possible to block cravings and the pleasurable effects of opioids and alcohol. Vivitrol binds to the opioid receptors in the brain, produces no opioid effects, and does not allow other opioids to enter. Because Vivitrol is an antagonist it will cause withdrawal if you still have any opiates in your system when you take the medication. For this reason, you will need to have gone through detoxification prior to starting the medicine and have ideally not taken any opiates for 7 to 14 days before your first Vivitrol injection. While it is not required for you to stop drinking prior to your first injection, research has shown that patients have a better response to the medication if they stop drinking at least one week prior to their first Vivitrol injection.

Once you have received an injection of Vivitrol, the medication acts on the receptors in the brain causing the blocking effect. This effect will slowly decrease over time, allowing you to only have to receive the medication once per month.

IS VIVITROL ADDICTIVE?

Because Vivitrol is a non-opioid, an antagonist, it is not addictive nor does dependence on the medication develop.

HOW LONG DOES TREATMENT TAKE?

You and your treatment team decide what will be an appropriate length of treatment to ensure the best outcome for you. Although short-term treatment may be an effective option for some people, it may not allow others enough time to address the psychological and behavioral components of their disease. Since physical dependence is only part of opioid dependence, the chances of relapsing can be higher with short-term treatment because patients have less time to learn the skills necessary to maintain an opioid-free lifestyle. There is no risk of withdrawal when Vivitrol is stopped; however, you are still encouraged to talk with your treatment team about any plans to discontinue treatment so they may assist you with your relapse prevention plan. Treatment with Vivitrol for as long as you need, combined with counseling and support, can often increase the level of treatment success.

WHAT WILL VIVITROL TREATMENT BE LIKE?

Please call our individual treatment locations to speak with a professional counselor that specializes in opioid addiction to book an appointment with our treatment team. On your first visit, the treatment providers; including a doctor, a nurse and a counselor will ask questions about use in order to provide the best treatment. If it is determined that Vivitrol is appropriate for you, the treatment team will take the necessary steps to get the medication and a nurse will give you the Vivitrol injection. You may be asked to wait for a period of time so staff can monitor you for any adverse effects. While there are some side effects to Vivitrol, they are usually mild and go away fairly quickly.