Stinging investigations by the New York Times, National Public Radio, ProPublica, and others have recently exposed how the drug maker Alkermes is promoting Vivitrol — a long-acting injection that blocks the effects of opioids — at the expense of other, better-studied treatments for opioid dependence. We can and should blame prescription drug companies for the misleading marketing they use to boost sales. But we should also look in the mirror and recognize that, in the case of opioid dependence, these schemes work so well because they reflect the bias — often unconscious and well-meaning — that prioritizes the fantasy of being drug-free over the real interests of people in need of help.

The investigations revealed how Alkermes marketers and lobbyists deride the daily administration of methadone and buprenorphine, two medicines that are the gold standard for treating opioid dependence. The sales pitch is that Vivitrol is an opioid blocker and “non-addictive.” The company has blanketed New York and other cities with promotional materials, and has dispatched lobbyists to prey on well-placed community worries about the spiking number of fatal overdoses.

The pitch is working. Sales of Vivitrol have skyrocketed more than 600 percent since 2011, and legislators in 15 states have written Vivitrol — by brand name — into their laws. Multiple jurisdictions have now created “Vivitrol courts.” These require drug offenders appearing before them to use that medication if they wish to avoid imprisonment.

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A recent survey of criminal justice representatives found that most favored Vivitrol over methadone and buprenorphine because, they said, the evidence showed it was better — an astonishing claim given that there is actually no evidence. Not a single published trial (one is now underway in New York, for which Alkermes declined to donate its product) has compared Vivitrol to methadone or buprenorphine.

What criminal justice officials and legislators mean but don’t say is that Vivitrol fits the bias against prescribing psychoactive medicines like methadone or buprenorphine to someone who has used an illegal drug — even if these medicines reduce HIV risk, improve family function, increase employment, and reduce the risk of heroin overdose. Vivitrol’s appeal is largely because its physical blockade of opioids echoes the urge to control and contain, with the medicine locking up receptors in the brain the same way we might lock up a drug offender.

For some people, this blockade is an extremely useful crutch, with the medicine helping them help themselves abstain from drugs. But for many others, the long-acting shot prevents them from getting high but doesn’t relieve their psychological suffering.

Vivitrol’s appeal is largely because its physical blockade of opioids echoes the urge to control and contain, with the medicine locking up receptors in the brain the same way we might lock up a drug offender.

Alkermes did conduct a single clinical trial to demonstrate the efficacy of Vivitrol for heroin addiction and secure its approval from the Food and Drug Administration. But the company did it in Russia, which bans both methadone and buprenorphine. Even there, where treatment options are severely limited, expensive, and abusive, nearly half the people in the trial who were getting free Vivitrol dropped out.

Worse still is the possibility that Vivitrol treatment may actually increase the risk for overdose. Using the drug requires patients to go through a painful detoxification. Evidence shows that those who return to using heroin or another opioid after a period of abstinence are at greatest risk of fatal overdose. We cannot know for sure if there’s a link between stopping Vivitrol and fatal overdose since Alkermes declined to track overdoses among the individuals in the Russian trial who stopped the medication. This omission raises the terrible possibility that the aggressive marketing of Vivitrol might actually accelerate the overdose crisis.

Would we really rather risk that our family members perish than include controlled substances like methadone or and buprenorphine among their treatment options? That has certainly been the Russian way — the country’s ban on methadone and buprenorphine has coincided with skyrocketing deaths from overdose as well as a huge and growing HIV epidemic fueled by contaminated injecting equipment.

Here, as in other matters, the Trump administration seems to have a disquieting alignment with the Putin government. Tom Price, the secretary of Health and Human Services, recently made headlines by disregarding years of studies and millions of stories of patient benefit when he dismissed methadone and buprenorphine as simply “substituting one opioid for another.”

For anyone who has seen the suffering caused by opioids, blocking them out — in the body, or in our society — is a powerful impulse. But when we allow it to deprive patients of options or to blind us to the realities of drugs and effective treatment, it begs the question of how high a price we are willing to pay for a drug-free fantasy.

And a fantasy it is. Vivitrol patients, who require a monthly injection, are not drug-free, and the medication’s price tag is many times that of methadone and buprenorphine.

Far more important, patients pay a terrible cost including, in some instances, their lives, when we allow criminal justice officials or health providers who have internalized the thinking of drug control to predetermine what treatments work. Anyone who insists that there is only one acceptable approach to treating drug dependence is motivated more by ideology than evidence.

The siren song of enforced abstinence — no matter the human or financial cost — is distracting, deadly, and as old as the drug wars.

Daniel Wolfe is the director of international harm reduction development at the Open Society Foundations.

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  • I am currently on vivatrol for opiate dependence, and it is working very well for me. I have been on both methadone and/or suboxone at some point in my life and the vivatrol is 100xs better for me. I do not have to go to a clinic every day. I just go to my doctor once a month which is way more convenient. It takes the urge away basically by me thinking there is no point of using if I won’t feel the effect of the opiate. I’d be more then happy to answer anyone’s questions about it. Strictly my opinion and how It has worked for me.

  • My bro’s been off black for over a year. both Vivitrol & Subs were used at different points during his treatment. Although I suspect that he will probably relapse, for now he satisfied with benzos and weed proud of him :’)

  • Methadone saved my life. But I knew I was done with heroin. I had enough. I went and got on it one day and even though my spouse was still using I stayed clean. Eventually my spouse came with me, got clean & stayed clean as well. I never went over 80mg which did cause some problems. Firstly being that I had withdrawals getting on the methadone (because I should of gone on a higher dose.) But I knew those withdrawals were minor compared to the pure h3ll I had been through with heroin. Suboxone always made me extremely nauseous and I had daily migraines with it so it was not an option for me.

    Anyways, I was on methadone and one day decided that I was done with it as well. I withdrew cold Turkey off 80mgs and it was not near as bad (again) as the withdrawals I used to go through so frequently as a heroin addict.

    I am clean today.
    My husband is clean today.

    That is what matters. I encourage anyone who feels it might help to give it a try.

    If someone is abusing the methadone (it is hard to not get caught abusing it… but it is possible) then they are not ready. But why take away something that saves lives because of people who are abusing it? That’s like removing every xanax, valium and every pain killer made because SOME people might abuse it.

    It saved my life. But I was ready.

    If you want help please dont do like I did and wait years to get on methadone because of the stigma around it. I never ever felt high (minus one “up day” and that high sucked lol.) I was on methadone for a year and a half and didnt go above 80mg even though my heroin habit was atrocious.

    It is possible!

  • Not a single mention of any of these drugs in combination with a MAT program. I am a Vivitrol program graduate. I now work in the field. I have two programs: one with Vivitrol and the other with buprenorphine. Combined with MAT, both of them can be successful. We have a higher success rate with the Vivitrol. But, you got to want it. If you don’t want it, nothing will help you get it.

  • The whole article is an obvious pitch for the pharmaceutical companies that manufacturers methadone. It is completely ignorant of the actual success of Vivitrol it is also effective in treatment for sevier alcohol abuse.

    • That’s not true. I’m a former addict who takes methadone on a daily basis and it has worked wonders for me. I take 90mg every day. I absolutely get no high from it whatsoever. I take no other drugs than my methadone, that’s it. Vivitrol is just narcan the exact same drug that brings you out of an overdose and in turn makes someone who’s addicted to opiates violently ill by slamming them into withdrawal. Bottom line is methadone and suboxone work for those who want it to work. I know addiction isn’t always pretty to look at…but until we as a society lighten up and get rid of the stigma nothing is going to change. The addicted mind is a diseased mind and until science figures a way to reverse it, methadone and suboxone are it, it’s a fact. I truly wish there was something better, I really do…because lord knows methadone and suboxone surely don’t work as good for some as it does for others…but again it’s really all we have at this stage in the game for people who simply can’t abstain.

    • Agree, but disagree about Vivitrol. Removing the stigma means removing the stigma right across the board. For some Vivitrol, in conjunction with a program/counseling/whatever works. Yes, there is the narcan jump, first responders hate it, but have learned to deal. That’s different from a regular program that uses what is a very effective remedy.

    • Interesting, didn’t realize using an extremely powerful, long acting opioid made you no longer an opiate addict. If it works I guess, my Hope is everyone gets completely clean as methadone and Suboxone are still very addictive and the withdrawals last for weeks to months.

  • In my experience, as I watched my husband enjoy his drugs, I don’t believe that vivitrol is the answer Every one expects. My husband tested this drug foolishly, after going to the dentist having teeth pulled and then taking the prescription hydrocodone for tooth pain. Which led him to take 5 in a 24 hour period, with all the physical appearances of being high but not feeling the effects (so he preaches). He still stubbles around with shallow breathing and pinned pupils. To then 24 hours after consuming, to become violently ill with vomiting and diarrhea. I don’t truly believe that it’s a fully effective product. It’s makes an addict feel they are sober but I fact they are a depressed empty shell of their old self. I don’t think any opiate blocker is the cure for addiction, without counseling and therapy. Ask yourself what are your reasons for getting high?? My husband can’t answer that question. Can you?

    • I have been an addict for 32 years….he gets high cause he wants to…its a choice…i now i have been there methadone and subs are drugs plain simply….addicts like myself always want the easy fix.. as and na work…they have a 100% success rate…i am the one who fails when I don’t do a few simple suggestions…its hard to get clean yes…but very easy to stay that way….

    • Jay hello my name is norbert machan im 34 years old and if one good thing i can say is ive been clean of opiates since Sept 18 2016 I’m proud but there is no other way I’m sorry about your husband .. yes u are right but can i tell u from experience um i started at 23 no pills straight H heroin started snorting in the first year IV use i died on 3 different twice because i didn’t know my sleeping meds don’t work together even thou it was over 12 hours later plus a non narcotic pills have half lives and once because i was to clean and i decided to do a Twenty $20 or 0.1 of a gram. you know being clean and thinking ur body can do the usual NO..
      I tried every way u can think of to mange my heroin addiction but even if i had millions of dollars guess what i know it wouldnt be enough i would either OD or go to prison done both i been to the methadone clinic getting i think the max was 120 unless u did some extra shit so u could get up to 150 like some kind of physical with there doctors at the clinic once a day 7 times a week $75 every week.. okay cool but the one thing is in a whole year every time i had to take a drop – drug test i couldn’t pass so after a year they came to me an said mr machan we cant have you here anymore because of my results so what they did was they let me come still but day by day they were decreasing my dosage so 120 Monday 119Tuesday 118 Wednsday and so on till i decided to get some heroin to substitute for the methadone it all leveled out i was back on heroin living but really dead because all i did with my life was always looking for my next fix or how i was going to get it i never done any sexual favors but caused a lot of trouble and a lot of heart pain for friends and family and always feeling like i wasn’t a human i was a SHIT BAG so the methadone clinic went like this my mother made sure to get me there every mourning by like 600 then by like 10-11 close to noon i would do a shot of heroin because the methadone would fade out not the well feeling but the mental high so iv would do a shot but it would have to be like double of what i usually did so like a Fifty $50 or a 0.3 now this mix the methadone and heroin it would give me pins and needles some people love it i hate it i like to taste it after i injected it u can tell a lot by the taste about ur product then by 3-4 in the afternoon I’m down the street smoking crack tweaking and guess what to come down 7-8-9 o’clock another shot of heroin then all over again so I’m still struggle of yeah forgot i don’t even got insurance no job not even Obama care nothing damn so i start going to rehab joints (free ones) and then boom i get prescribed suboxone ” praise the lord ” thinking to myself i wont be sick anymore yeah sounds good but I’m only taking them when i don’t got heroin then when i do take the suboxone I’m only taking little slivers of it so i wont be sick so if i do end up getting some heroin i will still feel the shot or the effects of the heroin plus LOL back then this is what I’m thinking i get 90 of these suboxone stripes a month and back then u or i could of sold each strip for $20 so why take the strip when i can get a bag of heroin that is when people were buying them so really still struggling and then not to mention if u were to cold turkey Methadone hum your body will go into withdraws in like 2days from your last dose but the sickness that comes with it is way worse then the heroin withdraw and can last all the way up to 30 days a whole month really what do u think the odds of an addict not doing something that they know is going to make um feel a whole 360 “hell to heaven” and this is in seconds very very hard now 30 days okay now suboxone if ur taking um as prescribed and stop ull start getting sick about a day later after your last dose but withdraws can stick around for 14 more days and stronger effects of withdraw then the heroin withdraw now what do u think an addict “ME” is going to be sick as fuck for 2 weeks naw I’m going to find something before the 14 days are up and not to mention that in these withdraws ur shitting puking and restless legs and worst one of them all CANT SLEEP FOR MORE THAN 20min at a time ull go crazy from just trying to rest but your body wont let u actually its kind of like having a bad FLU but even worse and now the heroin ull be sick anywhere from 10 hours to 24 hours from ur last use because its so cut up now that most of the time the people are only doing little %s of actual heroin because of all the different cuts including fentanyl that’s way stronger then heroin it self but the withdraw lasts 3-7 days now 3 days is hard enough i couldn’t do it but after u been down ,out, a piece of shit that wants to change and is really a good person just messed up and now I’m not even a productive member of society people rather look away then help and me trying to get one over on whoever i can for my next fix now methadone suboxone if ur taking them how ur supposed to they are made to make u go into an automatic withdraw called a precipitated withdraw and they are pretty intense or this can happen to if u take a blocker but u haven,t waited for the heroin or opiates to leave ur body basically like trying to rush thru the withdraw sux and if u try to do any opiates after one of these precipitated withdraws sorry wont help ull feel like shit waste of money time u just got to wait it out….. now Vivitrol for me Miracle when i get the shot in my ass check i don’t get any highs it works for a 30 day period LOL not day by day u know they say take it day by day naw i got a new plan on life i can plan out for a whole month now and know I’m safe because I’m an addict but this is my second time around on vivitrol the first time i was on it i would wait for like the 27 -28 -29th day of the month then do some heroin and then i would only get the slight taste and nothing else idk what i was thinking but right now I’ve been clean since Sept 18 2016 and today i can truly say i haven’t touched it nor tried any funny shit because i know i will lose but Jay now to get to ur question sometimes even tho we know whats best for us we don’t change because idk don’t care its to hard uhm fuck it I’m not causing anybody any problems shit i do what i wanna no its coming to reality with ur self and saying I’m done I’m tired i had enough i hate this life i hate myself i wanna change its knowing the difference between really wanting to stop and acting on that walk it like u talk it or like me i wasn’t ready to stop i was just trying to do everything else hoping something might work trying to make everyone else around me happy um rehabs and everything else didn’t work what worked was me going to jail and knowing i was done but i have a memory of my mother asking me this. Now this was before jail and i was still heavy in my addictions strung out /junkie she said DUDE wtf have u ever tried asking god for help LOL that’s what i thought then I’m in my cell and i think about what my mom asked me years ago boom it pops in my head and i ask for help one time in my cell but i said it out loud like i meant it i did i said lord please help me i don’t want live life this way anymore ill do whatever just help me please and then in mind i had the picture and this is what it was i said I’m going to sit this time as long as i have to sit and then get back on vivitrol when i get back out and that’s what i did in jail the day before i got i got the shot and been on it ever since I’m off probation i do smoke weed i have an nice paying job and finally living again not searching for my next fix sometimes u just have to wait and wait till the person had enough or they decide that that’s what they want u have to be committed not 99% only 100% and one again sorry about ur husband dang the doctor should of told u guys nothing can flush vivitrol out like suboxone and methadone because u wont get high or actually this is for alcoholics to so u wont get drunk or high and the next thing that it can lead to is death because u keep putting more and more of whatever drug till its to much in ur system like if u wern’t on the vivitrol and basically you overdose because ur body cant tell the effects cuts they are blocked and u keep taking more thinking somethings going to change but no no no idk maybe a better study on what ur going to take idk about na/aa because i don’t go i did a 10 month program in prison “rehab” in prison LOL but worked i was locked up for like 18 months then when i got out i had to do 1 year 4 months probation and complete an oaklawn treatment class called sorry i cant think of it but it was after care 16-32 week class at ur pace iv also finished that my plans are to stay on vivitrol as long as i can this my safety net this keeps me living i wanna live and just always remember THESKYISTHELIMIT i don’t want to be on something that controls my decisions if i have it or if i don’t VIVITROL really life saver

  • The author is either grossly misinformed or completely biased. I’d guess the latter. There is some obviously misleading statements made in this article. The truth is that addiction is not curable, not by vivitrol, or suboxone, or methadone, or AA, or a long stay in rehab. The disease is however treatable, and vivitrol is an excellent option. The urge to use doesn’t subside with suboxone or methadone use, in my experience, however when I started on vivitrol the turmoil in my head was quieted to a faint whisper. I could go about my life without being consumed by the thought of getting high. This is a tremendous leg up for someone suffering from an opiate addiction. It’s not a cure, but it’s a huge step in the right direction. Just like any treatment plan, stopping the drug use is only the beginning, we need to address the underlying issues, what causes us to use in the first place. The author wants to make this seem like a problem only linked to vivitrol, when of course it’s also true for methadone or suboxone as well. Claiming vivitrol could lead to more overdose is also disgustingly disingenuous. Yes, overdose is more likely after a period of clean time, but that’s not a reason to avoid sobriety. Is the message “don’t get clean you might overdose”? This can happen coming off vivitrol, coming out of treatment, being released from jail, or after years in a 12 step program. If you use opiates you run the risk of overdose, we all know this. It has nothing to do with using vivitrol. If you’re an addict or love someone who is an addict this drug should be at the top of your list for treatment options. Don’t believe this article in any way. I was a heroin addict for years and went through many types of treatment and vivitrol saved my life. I used it for about the first year of my sobriety and have now been clean and sober for over 6 years.

    • I have someone in my life I love deeply that is in recovery and is taking vivitrol. I’m sure its helping him to not crave but I know everything has a side effect. Since being on vivitrol for 40 days his behavior is not positive. He is selfish, almost abusive, numb, unfeeling. He has no personality. He has been an addict for years but now is living sober. Maybe the adjustment has been difficult but his behavior is unkind. He used to get verbally abusive under the influence but now acts the same way living sober. I’m sure the vivitrol is good for keeping the cravings at bay but he is unkind and devoid of a personality at the same time. I didn’t expect that. It has affected me as well

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