Sep 11, 2017 | By Marc Niedle
Better Living Through Pharmacology
Addiction & Recovery News
I’m always encouraged when options are developed for conquering addiction. By now, I hope everyone realizes that treating addiction can not be a “one size fits all” approach. We also need to understand that some portion of recovering addicts will need more than one tool to help them stay clean and sober. Things like cognitive behavioral therapy, the twelve steps and exercise work really well, but may not be enough when they’re used alone. Drug rehab is a controlled environment where drug use and relapse is highly uncommon and simply not tolerated, so it’s a lot easier to avoid temptation while being a patient. When you get discharged and back out into the real world you may find that you need some extra help to sustain your abstinence and recovery.
The new pill on the block
The pharmaceutical drug I’d like to give special mention and some information on today is called Vivitrol. Vivitrol is the brand name of an extended-release injection taken once monthly for the treatment of opioid and alcohol addiction. The main ingredient in Vivitrol is Naltrexone, an opioid antagonist. This is not to be confused with the drug Naloxone, a short-acting opioid antagonist used in an emergency to reverse the effects of opioid overdose. Vivitrol is used to treat opioid and alcohol addiction. It isn’t fully understood how Naltrexone positively affects alcohol addiction, but the theory is that it acts as a dopaminergic mesolimbic pathway modulator. The dopaminergic mesolimbic pathway is the primary center for risk-reward analysis in the brain and a pleasure center.
The fact that Naltrexone blocks opioids is the basis for its use in opioid addiction management. If a patient receiving the Vivitrol shot were to relapse and use opioids, they would not be able to get high due to the blocking effect. This is a helpful tool for two main reasons; if an addict knows that their relapse will be a waste of their time anyway, then they will be motivated not to use. Furthermore, in the case that a Vivitrol patient does relapse, they are much less likely to overdose because of the blockade effect, although overdose is still possible.
These days a lot more people know what Vivitrol is, but this hasn’t always been the case. The truth is this medication is still very young. In
With all of the positives you’d imagine that Vivitrol is a no-brainer right? Unfortunately there is one negative that needs mentioning; the price tag. The main ingredient Naltrexone costs about $0.91 per day. $0.91 per day is not much, but that’s when Naltrexone is taken by mouth in the tablet formulation. The once-monthly extended-release injection costs about $1,248.50; ouch. This is compared to Methadone, which costs about $400 per month, and Suboxone, which has a monthly cost of between $400 on the low end, and up to $1,000 on the high end. The cost of Suboxone treatment depends on a multitude of factors; your location, whether or not you have prescription drug coverage and which doctor you see.
The bad ol’ days
For many years opioid addicts didn’t have many options, they either went to one of the very few drug rehab centers, or they went on Methadone, the only medication assisted treatment available at the time. Now we still have Methadone, but we also have Suboxone and Vivitrol. Both of these medications are significant improvements upon Methadone. I’m certainly not attempting to disparage Methadone by any means, but most experts would agree, that of the available options Methadone has the most cons; Methadone requires patients to wake up very early to travel to a clinic, sometimes they may be very far away and inconvenient to get to, but they might be the only one for many miles in some regions of the US. Also, Methadone has a similar overdose risk profile to other opioids, and it can be easily abused or overused. Methadone is also notorious for a hellish withdrawal syndrome, like heroin but worse and for a much longer period of time.
Then in October of 2002, Suboxone was approved for the treatment of opioid dependence. This was a vast improvement over Methadone for multiple reasons; Suboxone doesn’t act as a full agonist, it is a partial opioid agonist. This means that it doesn’t give you the same high or effects that other opioids like heroin and oxycodone do. Suboxone also has a better safety profile; the drug has a ceiling effect, meaning that there is not an increase in effects as you increase the dose past a certain point. This means that the risk of overdose is minimal, and usually only occurs with polysubstance abuse, such as with alcohol or benzodiazepines. Furthermore, Suboxone is a drug that can be prescribed on an outpatient basis, allowing patients to continue leading a normal and fully functional life without inconvenience or interruption.
With that being said, although I have absolutely nothing against Methadone or Suboxone, I believe it is theoretically ideal to live free of the use of drugs whenever possible. If one of these drugs is needed then fine, I say take them indefinitely if you have to. The goal is to stay off drugs and to live a functional and fulfilling life, if one of these two drugs grants you that and nothing else worked then so be it. But now that we have a third option in Vivitrol that is non-narcotic and looks very promising based on the research thus far, I think we should utilize this medication as the initial approach, to avoid imposing the potential cons of Methadone or Suboxone maintenance
The bottom line
One thing we should make sure of is that President Donald Trump and his entire administration makes this medication available to every addict who needs it and is willing to try it. This is one pharmaceutical stone we should not leave unturned and now that Trump declared the opioid crisis a national emergency, he has no excuse not to fund it. The amount of progress the pharmaceutical industry has made in the past decade alone is incredible. If the government can allocate funds to make this drug available to every addict in need, we will be that much closer to solving this crisis.
