Vivitrol and the promise of abstinence maintenance

By Bethany Crotts

Treatment for opioid addiction is a multi-faceted problem, as it has proven to be a difficult disease to overcome and no single treatment strategy has been shown to be successful. Treatment programs focus initially on the acute stages of detoxification, with an estimated 80 percent using medications to assist the patient with the symptoms of withdrawal.

After detox, focus shifts to lifestyle changes, behavior modification counseling and establishment of support systems. Reportedly, however, more than 90 percent of patients relapse after completing a treatment program.

Difficult to Treat

Opioid addiction is difficult to treat because of the way opioids affect, and change, the chemicals in the brain. Opioids bind to receptors in the brain leading to the release of dopamine, a neurotransmitter active in the brain’s reward pathway.

In people not taking opioids, dopamine is released in response to natural phenomena, including food, drinking and sex, leading to pleasurable feelings. Opioids, then, make the natural high feel insignificant, causing the brain to crave the feelings associated with taking drugs.

Treatment Options

A treatment for opioid addiction, and prevention of relapse, is the use of naltrexone. An opioid antagonist, or blocker, naltrexone prevents the patient from feeling the pleasurable affects of opioids when taken. Traditionally available as a single agent or in combination with medications such as buprenorphine, it has more recently become available as a long-acting injectable.

Using a microsphere technology to slowly release the naltrexone over a 28-day period, Vivitrol allows the patient to receive an injection once monthly, rather than taking oral medication daily.

The injection is administered as a deep intramuscular (IM) injection, typically in the gluteal muscle, and should be administered by a health professional, including physicians, nurse practitioners, and pharmacists.

Vivitrol is indicated for the maintenance of abstinence from both opioid and alcohol abuse. While not indicated for the reduction of cravings, many patients report this, contributing to its overall effectiveness.

Side Effects

Potential side effects include injection site reactions, muscle soreness, cold symptoms, dizziness, and fatigue. More serious side effects include risk of opioid overdose, liver damage or hepatitis, and depressed mood. Vivitrol has not been tested in pregnancy, though it is known that naltrexone from tablets is excreted in breast milk and is therefore not recommended.

Because Vivitrol is an opioid antagonist, administration to a patient who currently has opioids in their system can precipitate withdrawal. To receive the injection, patients must have completed a detox program, no longer be experiencing physical dependence or withdrawal symptoms, and be opioid-free for 7-14 days; this includes naltrexone/buprenorphine, a common agent utilized in medication-assisted detox programs.

Patients are encouraged to carry a medical alert card, bracelet or tag with them. This can alert medical professionals that, in the event of an accident, opioid pain medications will not work and alternative pain medications will be needed.

As the opioid epidemic continues, the patients who strive to defeat their addiction are frequently discouraged at the failure of traditional detox and rehab programs. With Vivitrol as a promising option to assist in maintaining abstinence, increased knowledge and access are needed.

-Bethany Crotts is a PharmD student at Sullivan University College of Pharmacy.