In our previous post, we posited that all addiction treatment aims toward harm reduction and, therefore, all addiction treatment is harm reduction. We also explained that the Process Recovery Center utilizes two forms of medication assisted harm reduction: Narcan and Vivitrol. We have already dedicated a post to Narcan education, so it seems only fair that we spend some time providing education about Vivitrol and busting some of the common myths surrounding the medication.
Vivitrol is an opioid antagonist, which means that it blocks the opioid receptors in the brain. When the receptor is blocked, the introduction of opioids into the system will not cause a high. This essentially means that an individual who takes an opiate will not feel pleasure or receive pain relief. Vivitrol addresses the physiological component of opioid addiction but does not claim to be effective without counseling. In fact, Vivtrol acknowledges that no medication assisted treatment will address a psychological attachment to opioids. According to the Vivitrol website, “effective treatment programs often focus on both aspects of addiction through counseling and medication. When used as part of a treatment plan that includes counseling, Vivitrol can help prevent relapse to opioid dependence after detox”.
The numbers paint a hopeful picture: “During a 6-month, double-blind, placebo-controlled, randomized clinical study, compared to opioid-dependent patients being treated with a placebo and counseling, opioid-dependent patients being treated with Vivitrol and counseling had 90% opioid-free weeks (compared to 35% receiving the placebo) [and] a 55% decrease in self-reported opioid craving from baseline”.
We invited a Vivitrol representative to the Process Recovery Center to further explain the risks and benefits of the medication to our staff. Vivitrol is an ASAM, SAMHSA, and FDA recognized treatment; it is a non-addictive, non-narcotic medication administered as a once monthly injection. Vivitrol has no street value or contraband appeal. While Vivitrol blocks opioid receptors, it will not block other pleasure pathways. Exercise, sex, music and other pleasurable activities can still be enjoyed without interruption. Dog tags are distributed to clients in case pain management is needed in an emergency, such as a car accident or surgery. One of the greatest misconceptions about Vivitrol relates to the potential for liver dysfunction. Vivitrol can be used with proper monitoring in Hepatitis-C patients. Vivitrol is also appropriate for those presenting with a high metabolism; oral Vivitrol can be distributed to prolong the effectiveness of the injection through 28 days.
Detox is required before starting Vivitrol assisted therapy. The Vivitrol website states that “you must be opioid-free for a minimum of 7-14 days to avoid sudden opioid withdrawal”. Clients who take Vivitrol are also at increased risk for opioid overdose. After detoxing from opiates and beginning a non-narcotic therapy, opioid tolerance levels decrease significantly. In some cases, clients may try to resume using opiates at the same level they were using before they detoxed. Since their tolerance levels will be down, their bodies cannot handle the same opiate dosages. While on Vivitrol therapy, a client will not feel the pleasure of the high but will be at an increased risk for death. Overdose is still possible even though the effects of the opioids cannot be felt. It is imperative that clients be aware of this risk before starting Vivitrol. Since Vivitrol only blocks opioid receptors, healthcare providers should also be aware of the potential for clients to switch to other substances.
In addition to opioid addiction, Vivitrol can also be used to treat alcohol dependence. Alcohol withdrawal must be treated separately and can lead to death if not managed properly. While the outcome statistics are different for alcohol users than opiate users, the medicine works similarly in that it blocks the receptors in the brain from feeling pleasure when alcohol is ingested. It is possible to drink while taking Vivitrol – drinking just won’t bring about enjoyable results. Those who continue to drink may be engaging in habitual behavior. They may enjoy the bar, the taste of the alcohol, or the culture in which they’ve been immersed. These psychological and behavioral elements can only be addressed by counseling.
Our Vivitrol training opened with a quote from the National Institute on Drug Abuse (NIDA): “No single treatment is appropriate for everyone. Treatment varies depending on the type of drug and the characteristics of the patients. Matching treatment settings, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society”. We admire that Vivitrol abides by and promotes this philosophy. Our agency shares these values. As we’ve said before, we exist solely because we want to save lives. There is no “I” in “team”…and responding to the drug addiction epidemic requires a team response. We must coordinate and communicate with our peers in all corners of the addiction treatment realm to respond in a truly effective manner. We are thankful we are able to coordinate with Vivitrol and to offer the medication as just one element of a holistic treatment picture.
If you have further questions about Vivitrol, please visit their website ator call the Process Recovery Center at (888) 649-1149 and ask to speak to one of our medical professionals.
Autumn Khavari is the Process Recovery Center’s web content writer. She received an education in Substance Abuse Counseling from Beal College in Bangor, Maine.