By, Mark Sigmund MS, CADC, CCDP
I must say that I was really skeptical of Vivitrol when it first came out in 2006. As an addictions counselor, I guess it is ok to be skeptical of new medications, since drug companies often heavily promote the new drug. Originally, this drug had a black box warning in terms of being hard on the liver, so I was worried about using Vivitrol for a population that often has liver issues. At first, Vivitrol was approved to assist people suffering from an alcohol use disorder. It wasn’t until 2010 that Vivitrol was approved for opioid use disorder.
Later, the FDA cancelled the black box warning for liver problems. Running an intensive outpatient program for the past 12 years, I have witnessed the effectiveness of this drug in battling opioid addiction. Client’s who were given this once monthly injection when leaving rehab had much better outcomes than clients who were not given the drug at discharge. When I say better outcomes, the comparison is night and day. So many clients relapse when leaving rehab. These days, inpatient treatment isn’t lengthy enough, and the brain hasn’t healed after 28 days. Someone with an opioid addiction will often be on auto-pilot and go right back to using when they leave rehab. It isn’t there fault. There frontal cortex hasn’t regained control over the older reptilian brain, and they go right back. Vivitrol helps clients put the brakes on, and there frontal cortex back in control, and the outcomes of really good. For instance, at Change Your Directions Interventions, we always recommend that clients who go inpatient follow-up with the doctor about Vivitrol at discharge.
Vivitrol works by stopping the euphoria and sedation that central nervous system depressants like alcohol and opioids can cause. The medicine binds to those receptor sites in lieu of the intoxicating substances and stays there for a long time. Basically, you won’t feel high drinking or using opioids if you are given the shot. My clients have also reported very little cravings while on the vivitrol shot.
One of the reasons I like Vivitrol is because it isn’t a narcotic, and has no mind or mood altering effects. Clients who are on Vivitrol aren’t on drug replacement therapy. This is good because they can openly share at Narcotics Anonymous meetings, and are considered clean. Client’s on Suboxone, for instance, run into issues with celebrating clean time, because they are still considered technically “not clean”, since they are on an “addictive” drug replacement therapy.
One down-side of Vivitrol is that you need to be clean off Opioids for at least 10 days to safely get the drug administered. This might sound easy for a non-addict. However, 10 days clean is often impossible to achieve without going to a detox, for someone with a severe opioid use disorder. I have witnessed horror stories when clients were administered Vivitrol too early. They went into precipitated withdrawal, and all the opiates were knocked off their receptor sites, sending them into instant, very serious withdrawal. Two clients ended up the ER due to going into precipitated withdrawal. There descriptions of precipitated withdrawal were that it was the worst withdrawal they have ever experienced.
Another down-side of the drug, is the possibility that the client will try to overwhelm the blocker, which could lead to death. They would have to use huge amounts of opioids to overcome the blocker, and would instantly overdose. I have a heard a couple stories over the years of clients overdosing while on Vivitrol, but they have been few and far between. It is important that someone isn’t forced to get the Vivitrol shot. The client needs to have motivation to want to make changes. Otherwise, there is definately a risk that they will try to overcome the blocker.
In summary, Vivitrol is certainly a good option. I have witnessed the worst of the worst get better while on Vivitrol, a literal miracle drug in some cases. However, it is very important that clients continue with therapy and treatment while on the shot. Sometimes, clients become complacent and overconfident while on Vivitrol, and don’t fully follow-through with building a support system and their relapse prevention plans. They will often go right back to using after coming off the Vivitrol shot in a year or two.
Call Change Your Direction Interventions for professional help.