Top Menu

Vivitrol Slowly Makes Its Way Into Opioid Dependence Treatment

/By

A monthly injection to treat opioid dependence, approved in October 2010 by the U.S. Food and Drug Administration (FDA), has gotten off to a slow start but is proving useful in helping certain patients, say doctors familiar with the drug, extended-release naltrexone (Vivitrol).

The approval of Vivitrol gives substance abuse treatment providers an alternative to daily methadone or buprenorphine, which has been the standard of care for addiction to heroin or prescription pain medications. Both drugs suppress withdrawal and cravings, but many patients find it difficult to stick with daily treatment, and missing doses of those medications can lead patients to relapse. And because buprenorphine is taken at home, it can be diverted to street sales.

Vivitrol, initially approved by the FDA in 2006 for treating alcohol dependence, is known as an opiate antagonist, meaning it blocks the effects of opiates by occupying the opiate receptor sites in the brain. In contrast, methadone and buprenorphine are agonists, which work by mimicking opiates in the brain. 

Extended-release naltrexone is a major advance over oral naltrexone to treat substance abuse, says Herbert Kleber, MD, Professor of Psychiatry and Director of the Division on Substance Abuse at the Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute. “My patients say that every time they hold that tablet in their hand, they get a craving–they know if they don’t take it that day, they can get high. You don’t totally remove that feeling with Vivitrol, but at least you’re pushing it down the road for a month.”

Dr. Kleber suggests there are a number of potential candidates for Vivitrol, including those who have been addicted to opioids for a year or less. “Patients who have been addicted for more than a year may find that Vivitrol is not enough for them. Their brain has changed, and they may need an agonist,” Dr. Kleber noted. Vivitrol also can be used for people who are incarcerated, he says. “The criminal justice system doesn’t like agonist therapy, because they see it as replacing one narcotic for another. My hope is that they may be more inclined to use Vivitrol for probationers or those leaving prison as they transition to the outside world.”

Professionals who are in treatment for substance abuse, such as pilots or physicians, may also find Vivitrol an appealing option if their treatment must be supervised, since it does not require daily medication. Other possible candidates include patients coming off methadone or buprenorphine. They are at high risk for relapse during those first critical few months. Although they have to be off those maintenance drugs for anywhere from a week to 10 days to avoid precipitated withdrawal.

He tells patients that if they choose buprenorphine, they may be on it for years and it’s not that easy to get off it. How long an individual stays on Vivitrol varies, he says. “For someone who has some things going for them, like education, job skills or interpersonal skills, then I think six months might be a good number to shoot for. It’s between the three months the patient wants and the one year that I would like.”

Vivitrol should be used along with some type of counseling, Dr. Kleber says. “If you don’t use counseling, it can be difficult to get a person to come back for the next shot,” he says. “Vivitrol promotes abstinence, but that is not the same as recovery.”

Sales of extended-release naltrexone have been slower than expected, notes Ivan Montoya, MD, Deputy Director of the Division of Pharmacotherapies and Medical Consequences of Drug Abuse at the National Institute on Drug Abuse (NIDA), who was part of the FDA panel that recommended approval of the medication. “Alkermes, the company that makes Vivitrol, has responded to slow sales by increasing the price, which makes it less accessible,” he says. “There needs to be more education of physicians about the benefits of this medication and why patients need to be motivated to detoxify in order to use it.”

Cost is a Concern

A major issue with Vivitrol is its cost—approximately $1,000 per month. Dr. Kleber has seen the price shoot up to $1,295 for his patients. He notes that for patients with private insurance, Alkermes will reimburse patients for up to $500 for their copay.

“Right now there’s very poor penetration of insurance coverage, but that’s improving,” says Marc Fishman, MD, Medical Director at Maryland Treatment Centers and Assistant Professor of Psychiatry in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine. “Most of my patients are middle-class or underserved, and if there’s no insurance coverage for Vivitrol, then it’s not an option.” The entire cost for starting Vivitrol is especially high for his patients because he starts them on an inpatient basis. Because patients have to wait about a week after they have detoxed before starting Vivitrol, it’s difficult to administer the first shot on an outpatient basis, Dr. Fishman says. “If they start using again, then they have to restart the seven-day count. We tend to start people on an inpatient basis so I’m assured they’re opioid-free.” If a person takes Vivitrol while they still have opioids, buprenorphine or methadone in their system, it will precipitate withdrawal.

While Vivitrol is expensive, so is the all-too-often seen alternative, says Frank Vocci, PhD, formerly the Director of the Division of Pharmacotherapies and Medical Consequences of Drug Abuse at NIDA. “It can cost $55,000 to house someone in prison, compared with about $12,000 a year for Vivitrol—plus a person taking the monthly injections can still be working, so you’re turning a tax burden into a taxpayer,” says Dr. Vocci, who is now President of Friends Research Institute in Baltimore. “If we could treat people who were addicted to opiates just prior to release from prison with Vivitrol, that drug-free month might enable them to stay off opiates long enough to get their life back together rather than getting right back into the criminal lifestyle.”

Treating Younger Patients

Dr. Fishman says that although Vivitrol is approved for people ages 18 and older, it can be very useful for certain younger patients as well. “Youth opioid dependence is an exploding problem,” he says. “We haven’t thought of addiction medications as having a place for young people. The standard of care has been detox followed by psychosocial interventions, but adherence rates have been abysmally low. The standard of care ought to transition youth with opioid dependence to a full and comprehensive treatment program that includes medical monitoring and a strong consideration of relapse prevention medication.”

Because the methadone delivery system isn’t “youth friendly,” Dr. Fishman says young people with opioid dependence should be offered either buprenorphine or extended-release naltrexone. While some adults with opioid dependence prefer buprenorphine because they enjoy feeling some opioid effect, teens often don’t need that opioid reinforcement, he says. He notes that even though a monthly injection is easier than daily treatment in terms of adherence, teens still need their families’ help in making sure they keep appointments and keeping track of insurance benefits and copays, he adds.

Beyond Opioid Treatment

Vivitrol may one day be used for other types of dependence. At the recent American Society of Addiction Medicine annual meeting, researchers presented data about extended-release naltrexone for nicotine dependence, as well as amphetamine and methamphetamine dependence. “The preliminary results were very encouraging,” NIDA’s Dr. Montoya says. “It’s a medication that’s gaining a lot of momentum.  Hopefully it will open up more therapeutic possibilities.”

20 Responses to this article

  1. Nancy Ralston / June 25, 2014 at 4:46 pm

    My pharmacy at Target wanted $5,000.00 for a one month’s injection (only Medicare & part D & supplemental with AARP). Insurance denied. Who can afford this!?

  2. Avatar of Ken
    Ken / February 17, 2014 at 10:49 am

    Just found this forum, thanks for reading my post. I just started the Vivitrol 10 days ago, verdict is not out for me yet, I had horrible side effects. I feel I may be getting conflicting directions from my doctor, I have been on Suboxone for about one year for Tramadol addiction, just half of an 8mg strip per day, and also Antibuse for the drinking. I was told to stop the Antibuse, but continue the Suboxone while starting the treatment, which is what I did. I am reading that I should NOT be taking the Suboxone. Please add your opinions. Thanks in advance. Ken

  3. Avatar of Elise K Brown
    Elise K Brown / January 5, 2014 at 10:43 pm

    My son has been on the shot for a few months and doing well, state insurance does cover and the first shot I paid $647 dollars but saved his life. He had been in 9 rehabs and many hospitals and overdosed many times. He is 23 and in a recovery house second time first was 6 months and now going on 4 months doing well. He has a nine month old baby . The shot has helped him to plan his life go back to school and be a dad .Elise Ps Some people stay a year on it now they extended to two years ,I feel better when he has this he can’t use and for now that’s what works !,,, One day at a time !!!

  4. Avatar of Debra Lehrter
    Debra Lehrter / September 27, 2013 at 9:08 am

    VIVATROL WORKS! I took it for 10 months and have no desire to go back to drinking. It saved my life and my marriage. No side effects except for a little appetite suppressant.

  5. Avatar of Joanie
    Joanie / August 8, 2012 at 3:33 pm

    My son used Vivitrol in 2009 and was on it monthly for six months ever four weeks. Then we moved it to five, six then seven and eight weeks…and he went off it at a year. He has been clean and SOBER…for almost four years! He credits this drug…and his support systems to for his sobriety. Please don’t confuse this drug with methadone or suboxone! I hope more and more ins companies cover the expense of this valuable medication!

  6. Avatar of Dirk
    Dirk / May 21, 2012 at 12:43 pm

    I can see why this would be useful in prison but for SWIM it was a matter of being addicted, wanting to get off heroin, but still enjoying the feeling it produced. Suboxone worked amazingly well. It gives you a less intense version of the feeling you want without the withdrawal pain, which makes it easy to ramp down. Again, it has everything to do with a patient’s motivation to be off the drug.

  7. Avatar of Mary
    Mary / May 17, 2012 at 11:41 am

    Is there any help for people without insurance. My son has gone through 4 rehabs (2 IOP, 1 90 day, 1 60 day) and nothing is helping. He is again without a job, without insurance, no longer welcome in our home.

  8. Avatar of Jack
    Jack / August 2, 2011 at 3:48 pm

    My sons life is beging to get back on track because of Vivitrol. This an expensive drug and it is a shame that this is keeping others from benifitting from it. It does work.

  9. Avatar of Dan Cook, LISAC
    Dan Cook, LISAC / July 12, 2011 at 7:56 pm

    I am discouraged to see yet again our behaviorial health system looking at a drug to solve a problem. Maybe I am just jaded but it would seem much more beneficial to seek the solution to the problem rather than mask it with a different drug… :)

  10. Avatar of Ray
    Ray / July 12, 2011 at 10:15 am

    Dr. Vocci: Why assume that a person on Vivatrol would otherwise be in prison? ($55,000 vs. $12,000). BTW: Vivitrol may not be the only cost of care that applies to an annual cost. Faulty reasoning.

  11. Avatar of Julia
    Julia / July 8, 2011 at 8:25 pm

    We are lucky in Australia to have naltrexone implants, that last up to 8 months. But many people would rather die than let something into their body that gives them an irreversible situation. I’ve had 5 years of implants, its saved my life.

  12. Avatar of Charlie
    Charlie / July 8, 2011 at 6:28 pm

    I love how counseling was afforded a few brief words in the article. Throw the “replacement drug therapy” of the day at us because it may be financially beneficial to the physician. The bottom line is, none of it will work unless the client is ready to change.

  13. June Lazerus / July 8, 2011 at 5:30 pm

    What can be or is being done to lower that cost of Vivitrol so as to make it broadly available?

  14. Avatar of bobby
    bobby / July 14, 2011 at 10:51 pm

    This treatment is not a “drug” for a drug. it is based on the same treatment approach we use for people with any other disease. the medication is not addictive nor can a person become dependent on it. it can and has saved lives.

  15. Avatar of Sandy
    Sandy / January 16, 2012 at 8:56 pm

    If your adult son was trying to kill himself with alcohol, you might be more receptive to anything that might help…

  16. Avatar of MP
    MP / September 18, 2012 at 5:42 pm

    I agree with you Dan. Getting to the root causes of dependency is crucial and the powers that be need to open their minds to other options for treatment that focus on the healing of mental, physical, emotional issues causing dependency. I know about trying to save my loved ones life and medication is just a band aid apporach and has been a waste of money.

  17. Candice Besson / May 17, 2012 at 11:46 am

    Hi Mary, please call our toll-free Parent Helpline at 1 (855) 378-4373 to talk to one of our Parent Support Specialists to help you find support.

  18. Avatar of Lori
    Lori / October 4, 2012 at 5:06 am

    That’s what I need to hear positive stories! I absolutely agree with you Joanie this certainly does not sound like a replcement drug therapy, it sounds like an alternative! I often wonder if they make these things so expensive and try to keep them somewhat under the radar because truthfully, they make more money off of sick addicts and rehab.Not success! I’d love to try this and I am looking into it. Just heard about it 1 week ago.I’ve been struggling for 15 yrs on & off the past 5 on suboxone. Thanks again for a little dose of hope:)

  19. Avatar of Eileen
    Eileen / October 26, 2012 at 6:12 pm

    I had never heard of this drug until yesterday, but obviously it has been around for sometime. I see this as an alternative to actually giving addicts the drug, except with a smaller dose, ex (Meth, Suboxone)
    I hope the insurance companies will change and cover the cost. I see this as a life saver for so many of our youg people who have been really trying to stay clean for so long.

  20. Elise / January 5, 2014 at 10:51 pm

    Yes it works especially if you work a program with it !!! Elise

Leave a Reply

Please read our comment policy and guidelines before you submit a comment. Your email address will not be published. Thank you for visiting Drugfree.org

Disclaimer:
Reproduction in whole or in part of this publication is strictly prohibited without prior consent. Photographic rights remain the property of Join Together and the Partnership for Drug-Free Kids. For reproduction inquiries, please e-mail jointogether@drugfree.org.