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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  • And as for methadone!!! I have clinically been pronounced dead from that drug on several occasions and was strung out on subs for Years. They are Not helping the opiad epidemic. They are enabling it.

  • This post is political garbage. Whoever posted this was paid by big pharma. Addicts are dying by the thousands and your on here talking about Trump colluding with Russia which is BS. After 17 years as a heroin addict I have never been clean as long as I have today with 6 months and vivitrol plays a Huge role in that.

  • My son has been a drug addict for 20yrs. Has been on methodone ,suboxen and now vivitrol. Even though he no longer is using heroin, he still smokes pot,uses cocain and other drugs. Vivitol seems to help a little but is not the answer to our prayers.
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  • First of all there is no gold standard of treatment. The article misrepresents the truth. The gold standard medication keeps individuals addicted. There are many unethical doctors who prescribe Suboxone as a cash cow for there practice. I strongly recommend the publishers are do some research before they publish any misleading information.

  • I found this subject to be very interesting. I had been in recovery and drug free for 29 yrs before relapsing this past July. I have been on at least 4 Methadone clinics over my years of active addiction. I have also been a addictions counselor for 26 years prior to retirement and 3 yrs later a relapse. I worked for 7 yrs at a local Methadone clinic and I believe Methadone works well especially if used correctly along with having a support system (I have been in NA for decades. To make a long story short after I relapsed I now have to have an operation where I will be given pain meds (which I will take with someone overseeing the dispensing). I have tried Naltrexone and found that it make me nauseous and have headaches. My addictions counselor thinks that I should see a doctor to find out if there is another blocker medication that I could take and I don’t know that there is something else for me. Going back to your article I worked doing substance abuse groups in the state prisons in Michigan and you are right that the criminal justice system is pretty much closed off to a tried and true treatment with Methadone. Sorry to take up so much of time and space by rambling. I believe that the use of Methadone and Suboxone are great medications. Thank You Douglas Hathaway

  • This is silly. Everybody is so quick to blame everything on one thing and not look at the bigger picture and just sit there nitpicking focus and nitpick and focus on something to make it the bad thing when is the person that’s never the thing that’s the issue … Overdose due to stopping the treatment is no different then overdose after leaving a treatment facility which I’ve seen countless people die that way during my diction no different than somebody getting out of jail and overdosing and dying and I’ve never touched the shot… Of course when you don’t see every other avenue where Addicts relapse and OD instantly you’re going to focus solely on one and make it seem like it’s the bad guy out of all of them. Methadone and Suboxone sure they can use after it was likely not overdose because I’ve been getting high the entire time but just legally the shot offers those who are strong enough to say no a chance to have their head quiet down I know so many people that have succeeded from the shot and only relapse constantly using any other method it is very sad to see people relapse but is that anybody’s fault but their own? They know the risks of getting high after not getting high for so long no matter the reason why they weren’t getting high they know that they could die if too much is done The warning signs are everywhere it’s repeated to you constantly but yet they choose to do so knowing the consequences it’s not the drugs fault it’s the person and this is coming from an addict in recovery who made the choice not to get high after the shot was done because I made a choice to live

  • Overdose due to stopping the treatment is no different then overdose after leaving a treatment facility which I’ve seen countless people die that way during my diction no different than somebody getting out of jail and overdosing and dying and I’ve never touched the shot… Of course when you don’t see every other avenue where Addicts relapse and OD instantly you’re going to focus solely on one and make it seem like it’s the bad guy out of all of them. Methadone and Suboxone sure they can use after it was likely not overdose because I’ve been getting high the entire time but just legally the shot offers those who are strong enough to say no a chance to have their head quiet down I know so many people that have succeeded from the shot and only relapse constantly using any other method it is very sad to see people relapse but is that anybody’s fault but their own? They know the risks of getting high after not getting high for so long no matter the reason why they weren’t getting high they know that they could die if too much is done The warning signs are everywhere it’s repeated to you constantly but yet they choose to do so knowing the consequences it’s not the drugs fault it’s the person and this is coming from an addict in recovery who made the choice not to get high after the shot was done because I made a choice to live

  • I know this is an old article but the writer clearly knows nothing about Vivitrol. Vivitrol is a miracle drug!! The reason it’s superior to suboxone and methadone is that addicts cannot get high from it. Buprenorphine and methadone keep addicts in active addiction because they’re high everyday. Vivitrol prevents addicts from using because they know they can’t get high. Trust me I’ve been an addict for 35 years. I started taking Vivitrol injections 2 years ago and I’ve been clean ever since. I was also in methadone and suboxone programs previously and the desire to use never went away and I ended up using again after about 6 months of methadone and only 3 months of suboxone. Vivitrol is miles ahead of the others. Yes, it’s expensive but worth every penny.

  • For anyone reading look into the difference on what each drug does to the opioid receptors in the brain; weigh what is the better alternative between methadone, suboxone, subutex, and vivotrol – it is clear why vivotrol is clearly the safest and most effective. All drug companies lobby each drug they have in an almost sickening way; we can all agree that lobbyists have gone overboard on every facet of our country. But besides that fact; there is a reason that law enforcement (who do not recieve any lobbyists money) and medical professionals prefer vivotrol to methadone (which should be illegal due to the fact that you can still get high when using and the withdrawal can be fatal) and suboxone (which despite saving lives leads to withdraw unless a lengthy “ween-down” process minimaizes the long half-life of the chemical). I have personally been on suboxone for a year and a half and weened off which still produced withdraw. I have know multiple people on each drug mentioned and vivotrol gives you absolutley no feeling of opiate in your system (unlike the “gold-standard” drugs mentioned in this article) and blocks the ability to actually get high off opiates. The standard treatment is one shot of vivotrol every 28 days (or month) for 18 months; and EVERYONE I known that been on it and properly went through the correct program had no withdrawals when complete and stayed sober. My Sister who has worked as a probation officer for over a decade and now in the Federal level told me since vivotrol came out it has drastically reduced relapse and death among her clients; and it is the absolute best alternative. I have lost so many close friends and known so many that have lost their lives – this drug saves lives; and does not require a lifetime dependence as all the other alternatives such as methadone, subutext (both u can still use on) and suboxone. If you want to get mad at the drug companies ask why they deny people a 3 month cure for Hepatitis C unless they have over 10 grand or multiple denial letters from medicade to pay; instead of saying the disease hasn’t destroyed your liver enough to pay – they could just eradicating it for good but then the drug companies cannot profit from the suffering and death from later stage syrosis. This “epademic” infers that it is a recent event, but in reality has been going on for decades now and instead of blaming it is time to ask why and act. If vivotrol can return a person to being free of using and alive it is 100 percent the best alternative no question. 18 months and off with no issues; the author of this article seems to have his heart in the right place, but is placing too much emphasis on the business aspect of drug companies versus the saving of human lives. If vivotrol required a life-long commitment as the other alternatives suggest I could understand, but the truth is too strong for me to stay silent on this attack on a life saving medication that works. Read into it and how it works in the brain, look into the difference and see for yourself – ask any addiction counselor, specialist or doctor or probation officer.