What is Vivitrol?
Vivitrol is an injected drug, taken monthly to treat addiction to opioids or alcohol. It blocks the pleasurable effects of the drugs and reduces craving.
How does it work?
The active ingredient in Vivitrol covers up receptors in the brain to which opioids and alcohol attach. This can help addicts focus on the counseling and support groups needed to return to health.
How does Vivitrol differ from other drugs to treat addiction?
The biggest difference is that it is long-lasting. After one injection, the drug lasts up to 28 days, so patients don't have to take it every day. That eliminates the day-by-day battle to resist using drugs or alcohol. Vivitrol also acts on the brain in a different way. The other drugs -- buprenorphine (best knowns as Suboxone) and methadone -- reduce cravings by filling or partially filling the brain's opioid receptors. Vivitrol blocks off those receptors, like putting a lid on them. People typically stay on Vivitrol for less than a year, and can stop easily. Suboxone and methadone are opioids that have to be gradually tapered down.
Is Vivitrol better than the other medications to treat addiction?
Each drug has its advantages and disadvantages. Dr. Barbara Herbert, president of the Massachusetts chapter of the American Society of Addiction Medicine, breaks it down this way: Methadone is best for people requiring a lot of structure, because it requires daily visits to a clinic. Suboxone works for people who need a moderate amount of structure and are suffering from cravings. Vivitrol is for people who are stable but "need insurance," she said.
The Gosnold treatment center in Falmouth takes the opposite tack: Vivitrol, in combination with therapy, is the first-line approach. If the patient's recovery isn't advancing, then Suboxone may be recommended, said Margaret Shapiro, chief nursing officer.
Why is Vivitrol being offered to inmates just before release?
Vivitrol has several features that make it seem tailor-made for this population. Before taking Vivitrol, a person has to have cleared opioids from the body, by not taking any for seven to 10 days. This can be difficult for people starting treatment -- but inmates have already detoxed while incarcerated. Additionally, the first few days after release from prison are a critical moment of vulnerability; prisoners who have received a Vivitrol shot are unable to get high and thus protected from their impulses while they cope with freedom. Criminal justice officials like that Vivitrol cannot produce a high and cannot be diverted to illegal use.
What is known about Vivitrol’s effectiveness?
It is not as well-studied as the other addiction drugs. Vivitrol was approved for treating alcoholism in 2006 and for opioid addiction in 2010, based on clinical trials performed in Russia. In the United States, most completed studies have limitations, such as small numbers of people and short time periods. For example, a study of 34 inmates in New York, in which half took Vivitrol before release, found that four weeks later, those on Vivitrol were less likely to relapse into opioid use. But the study did not detect any difference in rates of reincarceration or overdose. It's not known what is the optimal length of time to take Vivitrol or whether cravings eventually return after stopping the monthly injections.