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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  • am i to understand that a person on methadone can be just as addicted to vivitrol? my friend started methadone for pain management now she has withdrawals if she does not have it what can she get to help with withdrawal?

  • Fellow commenters, this article doesn’t ask we debate whether one mat treatment option is better, it simply states that Methadone and Suboxone are considered to be the “gold” standard and that the makers of Vivitrol has put marketing before evidence. Doesn’t mean it’s a bad drug. Doesn’t mean it doesn’t work. Thank you, Mr Wolfe, for the much needed reality check! I had contemplated the future of extended release Naloxone but was unaware that compulsory use had already been implemented. Having a long personal experience with opiates I am angered but not surprised.

    If you ask any drug/alcohol counselor what is the most important element for recovery they with tell you it’s the personal desire to quit. I believe that compulsory treatment in any form is ineffective. Unfortunately, most treatment facilities accept clients who are court ordered or otherwise under duress. Prevailing public opinion is against practicing compassion for those who are chemically dependent. The longstanding war on drugs includes a malicious element that perpetuates the belief that drug use is bad simply because its illegal. Government/media has influenced the non-using public to accept a variety of penaltys that isolate, dehumanize and severely complicate the lives of people who practice substance use.

    We need to keep in mind that we are all fragile in different ways. Social and legal pressures designed to bring an individual’s life to an artificial “bottom” not only serves to break spirits, it’s often more deadly than the drugs they use.

  • Julie it all depends on the person. I planned 12 shots I had a good friend do the same hes been clean over 3 years now. I’m gonna look at my situation after a year and make a decision. Some ppl may want it longer than others. My only concern is how hard it can be on your liver. But I know numerous ppl with help c that have been on vivitrol for extended periods and their liver counts are perfectly normal. The website brings it up but I’ve heard its since been a risk that was not as serious as originally thought. The thing about vivitrol is there is no addiction causing ingredients so no withdrawal. So besides 1 to 2 days a month where my butt is a little sore I dont even think about it. I’ve missed appts too … absolutely no withdrawal or problems. So basically to answer you its case by case. If a person is working on changing the things that made them use heroin or being involved whole heartedly in a self help program they may not need it long. If you dont work on shit dont change your thought process or behavior and the way you process feeling etc you may wanna stay on it cause the risk of relapse is very high. And just fyi I was a heroin addict for about 10 years and addicted to oxy for about 3 years prior. Nothing worked. I managed 3 years with 10 years of prison time over my head as soon as that was over I used … literally in the parking lot of the court house…. that was Nov 2012. Last heroin use was June 10 2018 ….. 6 years of trying literally everything with no success. I managed 4 months in 2015 that was it beside a whole lot of miserable 5 to 7 day withdrawals swearing off heroin til I felt ok enough to get out of bed then i wouldn’t last 15 mins. I wanted to die everyday and then I almost died in June…. like very serious infection that almost cost my arm and left me with nerve damage and one hell of a scar. I agreed to try vivitrol and haven’t looked back. The author of this article is …. well I’ll keep that to myself

  • This is retarded. I was addicted to heroin for nearly 10 years minus 3 years clean. I’ve lost EVERYTHING numerous times. I had absolutely ZERO success with suboxone and subsolve ie. Bup. Or methadone. Methadone was the absolute most miserable thing I’ve ever done. It was exactly like using heroin … its a full on synthetic opiate … created by nazi Germany to replace pain killers that were not being shipped or manufactured. It’s long acting and ruins your teeth and body. I was on it almost a year and got to around 65mgs which made me comatose at night and sometimes during the day but 55mgs I got sick before 24 hrs … there was no middle ground. Physically emotionally and spiritually I felt exactly the same as using heroin so inevitably I started using which got pretty bad considering how bad the pain of methadone withdrawal was so I couldnt stop. When I finally got low enough to transition to subsolve it was a living nightmare… way worse than any heroin withdrawal I’ve ever had (and I was doing 1 gram of fentanyl a day at one point) once on a sustainable dose of bup I had even less success than methadone. I was on bup for 8 mos pissed 2 times a mos and had 1 …. ONE … clean urine. I ended up in the hospital with acute compartment syndrome and had a faciotomy performed on my left arm to a. Save my life. And b. Save my arm. I’m a master ase technician so that arm is pretty important to my kids and family…. I detoxed in the hospital over 6 days came home and at around 30 days clean I started vivitrol. Honestly I dont know how true the stuff they say about cravings is but I can say I’ve had thoughts here and there but no overwhelming urge to use opiates. Oh it’s now been 6 months with no opiate use. I plan a minimum of 12 shots and will re-asses my situation then. But you cany be serious saying bup and meth are more effective and better. They are the absolute worse drugs ever made. Maybe a short few day detox is one thing but extended use is bad. And u failed to mention that suboxone had naloxone in it … naloxone =naltrexone=vivitrol=narcan. Stop misinforming ppl with your incompetence. If you haven’t experienced it STFU! I almost died drying to stay clean with your so called miracle drugs. Vivitrol saved my life and gave my life back to me. And fyi I have lots of addict friends and they will all tell you the longer you take those drugs the harder it is to get off. Methadone is almost 100 percent life sentence. And look at the ppl that have taken it for years…. no teeth looking like death. My best friend was o suboxone for 7 years it took almost 8 mos to fully withdrawal. You know what happens when I miss a vivitrol shot? Absolutely nothing. No withdrawal psychological or physical… so how tf do you even begin to compare? You honestly sound like someone just like the dr that over prescribed and got me addicted to opiates in the first place smh. You are an asshole

  • I live with an addict of heroine and he was on both methadone and buprenorphine. He learned quickly how to manipulate those medications so that he could still use. Vivitrol is helping him as kbowing he can’t use has help ease the cravings and mental need to use over time. Its just my opinion from what I have seen with him and others it works well. I welcome others comment and experiences but please be respectful. Good luck to all suffering and to those who love them.

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  • I’ve been clean on Vivitrol for almost 3 years, after having multiple relapses and two near fatal ODs while on Suboxone for the preceding 7 years. I have zero cravings, and am back to being who I was over a decade ago. When I was on subs, my life was no different than when i used heroin regularly, just replacing one opioid for another.

    • How long does one have to remain on the shot? That’s the only question I can’t get answered? What happens when one stops the shot? Do you have to remain on it to stay off Heroin? Does it ever end? That’s what I want to know… please

  • Just noticed the author of the article works for a Open Society Foundation, which is a political lobby, not a medical research institute. He’s not a doctor, healthcare provider, or researcher. Stat News — you should vet your contributors better next time.

  • I am on Vivitrol now and it gives me thoughts of suicide and absolutely no motivation and I have intense urges to use other drugs like meth when the shot is close to wearing off before my next injection

  • As a 12 year methadone consumer, followed by 6 years of suboxone, I don’t really trust Big pharma or their drugs any longer. I put my faith in kratom, and with it’s help been off both subs and methadone since August 2017. I know the FDA are waging a war on kratom at the moment, because of course it’s cutting into their profits, but it feels much more natural to me without paying hundreds for other addictive treatment option, and helped with anxiety, depression and cravings/withdrawl as well! good luck to everyone fighting one addiction or another!

    • The person who wrote this article should be ashamed of themselves and has absolutely no idea what they are talking about.

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