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tinging 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 take Vivitrol through the VA and theyre wrong about it not getting rid of cravings. It takes about a week but it does help with them. About half the people in our outpatient group take Vivitrol instead of Suboxone or Methadone they all say good things about it. the hardest part was the 2 weeks you have to wait between switiching from Suboxone to Vivitrol. Suboxone withdrawal are a joke compaired to heroin but they linger the full 15 days. I guess my group is a little different than average addicts we all were self medicating to treat some form of combat related PTSD and the PTSD treatment also really helps instead of drowing it out with drugs or alcohol we learn how to deal with it. In the beginning though all I had was the Vivitrol and it works 92% success rate according to the Docs at the VA hospital.

  • Suboxone has buprenorphine in it, as well as naltrexone. Vivitrol is only the blocker, naltrexone. Subutex is just buprenorphine.
    I recently was unjustly kicked out of my methadone clinic, NOT GIVEN ANY TAPER FROM 145 MG. This was all because I could not pee with a nurse watching me, after I called in, but arrived late. I tried to give a sample from a monitored UA for a week straight. I begged for a regular UA or saliva test, just to be denied. Was not allowed to see a doctor and WAS NOT GIVEN A KICK KIT OR CLONIDINE.
    In 2018, why is this inhumane and unjust treatment still happening? I would have died, from the extreme withdrawal, but I’m too strong. I could have died, and I have a daughter. I was late, that was the reason my clinic did this to me after being a loyal, model patient for 6 years. I never even had a dirty UA for 5 years. We all need to come together and fight for those suffering in this opioid EPIDEMIC. I felt so betrayed by the “medical and treatment professionals” who I credited as saving my life. It’s a joke. They play God! Its true. It’s a revolving door of employees, and Pardon my French, a cluster-f**k of confusion and chaos. I am not discouraging any one from Methadone Clinics, nonprofit clinics seem to be much better than the “FOR PROFIT$$$$$$” one I had the misfortune of attending.

    • You were a model patient for six years? I mean…six weeks…six months even for recovery and to be clean and off all drugs…sure. But six years and you are still taking drugs? They didn’t betray you…you betrayed yourself and keep doing it.

    • Nathan Wilson theres a reason it is called Opiod replacement therapy some people will be on Suboxone or Methadone for life in Vancouver BC and parts ot Europe they even have clinics that just give medical grade herion 3 times a day, not that I think its the best way to go about it personally I tapered off Suboxone and switched to Vivitrol

  • I’m not seeing how this much different then suboxone. I am a recovering heroine addict clean over eight years now with the help of suboxone. Suboxone has got me away from ththe drugs but it comes with its own issues. I been stuck on it for 8 plus years. The withdrawal are worse then any real opioid in because it feels the same way as heroine coupled with the fact it can last for months and months called withdrawal syndrome. I work everyday and keep a roof over my head and I am not able to go thru the withdrawals or I would definitely lose my lively hood. I can’t arford that. I have came too far. So Vivitrol can help but u will still have to go thru the mental issues along with addiction. I am wondering if vivotrol is addictive like suboxone

    • Hi,
      From what I’ve read on the drug, it has zero opiates and is non-addictive.
      Suboxone and Methadone both have extremely bad withdrawal symptoms. Some say Methadone has the daddy of all daddy withdrawal symptoms (worse than heroin!) To me I found this to be true, as I have experienced the two and Methadone withdrawl is MADDENING and has brought me close to suicide!
      So many people think Suboxone does not have withdrawal symptoms. WRONG! They come with awful withdrawal as well.
      Honestly, there is no opiates out there, when taken long enough, you can avoid withdrawal. Some people after leaving the hospital complain of flu like symptoms and feeling awful, not wanting to get out of bed. What they don’t realize, which they wouldn’t, is they are experiencing mild withdrawal symptoms from receiving pain meds while in the hospital.
      I had just spoke with an addiction doctor a couple of weeks ago and he told me that in the beginning, Suboxone was only supposed to be given for a certain amount of time, and dosage was to be reduced until patient was medically taken off.
      Now Suboxone, like Methadone, is to be given at a comfortable dose for the rest of the addicts life. Through studies, it showed that only 5% of opiate addicts make it.
      I’m not saying it can’t be done, but in my case and many others I have tried to get off of opiates and even getting past the hellish withdrawls, my body and brain could not recover fully.
      Now I look at my daily dose of Methadone as a person who needs their insulin like a diabetic would. I have no shame. I am able to function as a normal person and to look at me, you would never know I’m an addict.
      So after this long reply, never, ever feel bad about taking your Suboxone, not saying you do, but there is no shame in our game!!! 😁🤗❤️💙💜

  • I’m just not seeing how Vivitrol can be helpful. Since it’s not an opioid, it does nothing to reduce cravings. So other than eliminating the possibility of a spontaneous relapse (by blocking opioid receptors), what good is it? It doesn’t appear to be any different for the drug addict than Antabuse is for the alcoholic, and as far as I know, Antibuse has always been regarded as practically useless in obtaining long term sobriety. Am I missing something here?

    • As some one who takes vivitrol it lasts 6 weeks and at the VA hospital we get our shot after 4. It does help with the cravings it takes about 3 days to a week to help with the cravings it has a 92% success rate according to the addiction treatment center at the VA and everyone I met on it have nothing but good things to say about it. Then again Vets mostly use because of PTSD treat the PTSD most of us stop caring about getting high or drunk to escape not sure if that makes us different than regular addicts or not I’m not a Doctor.

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