Opioid Addicts Have a New “Shot” at Treatment

Several patients last week asked me if I’d heard of the new “shot” for pain pill addiction. It became clear they were talking about Vivitrol, the brand name for the extended-release naltrexone.

This is not a new drug, but a newer formulation of an old drug. Naltrexone is an opioid antagonist that’s been used in tablet form both for alcohol addiction and opioid addiction.  Naltrexone attaches to opioid receptors, but doesn’t activate them, and prevent other opioids from activating the receptors.

It’s used for alcohol addiction because it appears that in some alcoholics, part of the pleasure from drinking is mediated by the opioid receptors. When these alcoholics take naltrexone pills, it doesn’t make them sick, but takes all the fun out of drinking. Alcoholics taking daily oral naltrexone have fewer drinking days, and drink less if they do have a relapse back to drinking. It’s never meant to be used alone, but in combination with some sort of counseling and recovery program.

The problem with the oral form is that the alcoholic has to remember to take it each day, so when Vivitrol released, it meant there was a way to give the medication in shot form to last a month at a time. However, it’s significantly more expensive than oral naltrexone and it’s not a painless injection to receive, according to many patients.

For some reason, the patients I’ve seen lately who asked about the new injection for pain pill addiction seem to believe this injection will prevent opioid withdrawal or prevent cravings. It doesn’t do either. In fact, it can’t be taken until 7 to 10 days after the last opioid, or it will cause opioid withdrawal. Some sources say it can be started sooner, but people who have been on methadone may need to wait even longer.

Naltexone does work for opioid addiction, however. In the initial trials, patient on Vivitrol had significantly more opioid-free urine drug screens that patient receiving placebo injections.

In the past, medical professionals recovering from opioid addiction were often required to take naltrexone as a condition of their return to work. Doctors, pharmacists, and nurses may need to work around opioids, and if they relapse while taking naltrexone, the illicit opioids will have no effect. The antagonist thus serves as extra insurance against a relapse.

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One response to this post.

  1. Yep, I’ve seen the same relapse-proof effects with alcoholics, as well. I think it’ll be interesting to see the development of drugs similar to Naltrexone in the next couple of decades. Given its effects on the opioid receptors, it’s not only effective for alcoholism and opiate addiction. It’s been used to treat obesity, as well – a success which might help us learn more about the nature of food addiction and fat gain. Overall, the opiod pathways seem to have incredible effects on a number of different processes, and I’m willing to bet that Naltrexone and similar drugs might be used to treat a wide array of problems – drug-rlated and otherwise.

    Reply

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