The science of treating opioid addiction has become increasingly popular in both medical circles and in the addiction treatment community.
For decades, medical professionals and even popular recovery organizations did not quite understand how giving an opioid addict a replacement medication could actually facilitate recovery.
Part of the dilemma was that those who defined “recovery” did so using an old school philosophical approach originally crafted for alcoholism. But science has taught us that not all addictions are exactly the same. While there are certainly commonalities between the various substance use disorders, there are very important distinctions and differences which affect the recovery process.
You cannot prescribe a medication that is effective with depression, and expect that same medication to resolve schizophrenia or an anxiety disorder. While they are all mental health disorders that can debilitate a patient, there are critical differences between these disorders and in the overall treatment plan for addressing each one.
Similarly with addiction, science is teaching us that a one-size-fits-all approach to addiction recovery is detrimental and often unproductive.
With opioid addiction in particular, the disease progression is quite unlike most other addictive illnesses. While the medical profession has evolved that understanding, the recovery community and general society has at times struggled to comprehend the necessity of medication-assisted treatment for the opioid addicted.
Physicians, Nurse Practitioners, PA’s, Nurses, and Counselors all play a part in educating patients, their families, the community, and government on the key role that medication plays in the successful management of an opioid use disorder. Methadone, subutex, suboxone, vivitrol, and other medication choices make the difference between recovery success and repeated recovery failures.
Posted in Addiction Treatment, Buprenorphine, Methadone, Methadone Clinics, Methadone Maintenance, Suboxone, Suboxone Doctors, Subutex, Vivitrol
Tagged methadone dosage, suboxone film, Subutex
Naltrexone is an opioid treatment medication that works very differently than either methadone or buprenorphine.
Naltrexone functions as an opioid blocker that interferes with the euphoric effects of opiates. Unlike methadone, naltrexone does not eliminate opioid withdrawal. So it is typically only begun following a successful period of opioid detoxification.
Naltrexone is taken as a pill or as a time-released injectable. It blocks the feeling of getting high thus deterring a person from continuing in active drug use with opioids. If there’s no pay off for using, why do it?
Some individuals who don’t necessarily require methadone or buprenorphine can effectively utilize naltrexone as a component of their recovery program. Vivitrol is the time-released, branded version of naltrexone that is taken once monthly as an injection. With Vivitrol, the naltrexone remains active in the bloodstream for 30 days and blocks the effects of heroin or other opiate use. This reinforces one’s focus on recovery choices and can reduce opioid cravings.
Patients receiving naltrexone may develop a lowered tolerance to opioids over time, and should remain aware of the risk of opioid overdose should they relapse. The medication is also used in the treatment of alcohol dependency and has been shown to reduce the euphoric effects of alcohol consumption.
Naltrexone is not to be confused with Naloxone. Naloxone is the opioid overdose reversal medication that has recently been in the news for saving thousands of lives across the country.
Vivitrol® is a new product of Alkermes (a U.S. based pharmaceutical company who specialize in disease management medications). Vivitrol received FDA approval in October 2010 for use in the prevention of opioid relapse following opioid detoxification. It is an extended release formulation of naltrexone designed to be administered through a once monthly IM (intramuscular) injection.
The medication is a non-addictive, opioid antagonist that blocks the effects of opioids, and thus discourages opioid misuse since no subjective euphoria is experienced. Opioid addicted individuals are often at high risk for relapse following opioid detox, and intensive support is very helpful in assisting these individuals with establishing a comfortable, lasting sobriety following successful opioid detox.
Vivitrol must be administered by a healthcare professional, and recipients should not have active liver disease complications since naltrexone (the active ingredient in Vivitrol) is contraindicated for those with acute hepatitis. Like any medication-assisted intervention, Vivitrol should be used in conjunction with ongoing behavioral health counseling in order to maximize a client's chance of successful long term recovery through skill development and lifestyle change.
The medication is not inexpensive (obviously a patented medication with no available generic equivalent). But considering its potential benefit to those in early recovery, it may be a worthwhile short-term investment in the first 30 to 90 days when recovering persons are at highest risk for opioid relapse. An obvious benefit of Vivitrol is that the patient does not have to take a daily pill, so either accidental or purposeful missed doses are not a concern.