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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  • As someone on Vivitrol, it is an amazing medication for those who truly want to get clean and who are willing to put in the legwork. Just going and getting your shot once a month probably won’t be the answer you’re looking for. You have to (and most places require) do some sort of counseling or other program along with the shot to fully start your road to recovery. I went to rehab for 6 weeks and started on the Vivitrol shot immediately upon getting out. I also immediately started IOP (intensive outpatient) therapy groups three times a week at night for three hours each night, as well as one on one counseling. I feel the Vivitrol shot has helped curb cravings (for alcohol and other drugs I was addicted to) but I also have put in the time in other areas of my life to ensure lasting sobriety. I am 4 months clean from all substances, about to be done with IOP (still will be attending other meetings and individual counseling) and I am feeling better than I ever have in my life. Can I say with 100% certainty that the Vivitrol has been the main factor in my recovery? No. But I know it has helped. I plan on staying on Vivitrol for at least the recommend 13 months. I applaud people who take Suboxone the right way and can lead a normal life again, but I did not want another substance that would make me feel “high” and Vivitrol does not, in any way. And if someone is willing to get clean and put in the work, Vivitrol is an amazing tool in the road to recovery.

  • I recently had a friend who passed away after his vivitrol shot ran out. This article depicts it as something bad however in reality the person who can take vivitrol is technically “clean” and gone through all of the physically withdrawals meaning they are further down the path to a sober lifestyle. That’s why it’s deemed to be better than sub or methadone in my book. Ppl on those substances are heavily dependent still on opioids/substitutes. So only reason for higher deaths is because the tolerance of those individuals on vivitrol is significantly lower than those on other substances. It sucks but ppl need to just understand that they can’t do as much as they used to if they are going to relapse. Hopefully get clean instead of relapse but if u are gonna go back to using take extra precaution in doing so… RIP GANS.

    • This probably was because this person used opiates which created an OD. The Vivitrol did not play a part. Vivitrol or not, when you are clean, your tolerance changes. So whether he used a large dose ON or OFF vivitrol, they would Overdose. . .also, you are OVERLY educated on this when given this medication… Physicians will review 100 times that using will not get you high, but once you continue to used, it will break the barrier.

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