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.


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 hate it. Im at the end of the month again & being high would be way better than anything my life “brings” me, im dedicated to the program of recovery but, life sucks with & without I rather feel good while it sucks regardless

  • Have you tried any of out Daniel? I have and control is a godsend after trying all 3 over the last 7 year’s vivitrol is bar none the best and most all ideal options [largest growing addiction treatment company in the nation] top most consistent patients are all vivitrol

  • My son has been a addict for 4 years now and he did the methadone treatment for 3 years and it was horrible. I hate methadone and anything associated to it. You are a prisoner to these money eating treatment centers and he still used while on it. He went through a terrible time trying to get them to lower it so he could go into rehab to detox off of it which was a job in itself. We had a hard time finding a rehab that would do it and they wanted him on a very low dose for two weeks before they would even take him. It’s all about money and he did get out of it but still has the effects from taking methadone the pain in his joints and bones. So don’t try and say it’s better to go with that treatment because it’s not it should be banned.

  • As someone who has battled with chronic pain and physical dependence to opoids, let me be clear it’s not a matter of will for me, I have kicked the habit many times. I’m just in too much pain and can no longer function properly without them, that In turn caused my dependence. Some don’t realize the depression that follows detox (sometimes for years after sobriety). Personally It’s about individual quality of life. Every person has their own unique threshold when it comes to pain which is derived by both nature and nurture. If a person is self-medicating, chances are there is a good reason for it. I’m not saying this describes everyone, in fact I’m saying just the opposite. To me addiction is just a label that is far to broad to ecompass all of the many facets and comorbid disorders that fall under that title. The stigmatization and shame that enshrouds this common problem we have shared since written history. We need to shine a light on this ugly secret we have kept under lock and key as a society. I couldn’t agree more with your viewpoint of vivitrol. I think for some people who truly want to completely cessate for whatever reason this might be a nice step down from other drugs like methadone and suboxone. However as we have always know, if you force an addict to do something when they aren’t ready, the results aren’t usually pretty. Addicts in general are usually very sensitive people that are in a lot of emotional and sometimes physical agony. If you completely remove a vulnerable person’s last and only escape; one could easily presume they are unable to face without some sort of help suicide seems like the next escape. We just need to start treating people like people. We all have our vice, even if it’s soap operas. Some vices just have more consequences than others and can even become a disease like opiates. There are no hidden dialysis clinics on the sketchy side of town surrounded with razor wire. No other disease ever constitutes a court mandated medical treatment or incarceration. I’m not saying addicts shouldn’t me held accountable for the crimes they commit to feed a habit, I’m just saying we need to stop punishing people for solely relying on a substance or just for the use of a substance…especially if the substance is prescribed. Ask yourself what the first thought that comes to your mind when you hear methadone clinic, then ask if that’s fair or something that has been instilled in you by the media or your parents even? If we are going to call it a disease we should treat it like every other disease. Segregation is alive and well when it comes to psychiatric and substance use disorder clinics. Lastly ask yourself how many generally happy people you have met that go to a methadone clinic, Or if you’re brave enough go to one yourself just to see. You’ll see it’s just a bunch of people trying to make it, you might even see me. As as an addict looking back at you, “the normal population”, people watching inflated news stories about scary people like me, I can tell you with unwavering certainty that the only thing I’m afraid of at this point is you. Thanks for reading my rant.

    • Your comment brings me hope. Not so much that the general public will end the stigmatization of drug users/former users, but that one day, I will hold my head up high. I won’t almost-run from my car to the door of the clinic that saved my life. The “scary” to “normal” people place- where, you’re right, a roomful of people just trying to get better reside every morning.

      I recently had to guest dose, for two weeks, at a clinic 4,000 miles away from my regular clinic. It was in Hawai, and when getting everything set up to guest dose, I had romanticized it in my head. I’ve been going to the islands since I was a baby. In my head, the clinic would be very nice, beautiful like everything else in Hawaii, right? But I was very wrong. It wasn’t as pristine and clean as “my” clinic. The people seemed different- I was really uncomfortable. Imagine that- people who live a completely different way, across an ocean and most of the United States…people are different. I feel so stupid for my judgemental attitude towards the employees & even those that I sat with every morning. Your comment just made me realize how wrong of me that was. They were just like me. Just trying to do better. ❤️

  • Methadone better than Vivatrol? Have you even known anyone on methadone? It is very addicting and hard to get off of once you start it. Years ago I would sit outside a methadone clinic in a patrol car and monitor the comings and goings. I would see these “patients” walking as round like zombies trying to sell their supply so they can buy heroin. All the drug related foot traffic ruined the neighborhood, and the same people were there several times per week. Their lives still centered around drugs.
    On the other hand I have seen Vivitrol change lives almost immediately. I have made thousands of illicit narcotics arrests, and I tell you that Vivitrol can be a game changer for any opioid or alcohol addict. It is a true life saver. It is just too expensive for many addicts. That is the only real problem with the drug…

    • You saw the same people all the time because you have to go every single day to take your dose. You take your dose right at the window, so you can’t sell it. If the clinic is closed on Sundays you get ONE take home dose per week. So, you only really have one opportunity per week to attempt to sell your methadone. You pay for each dose as well, so you’re not going to make hardly any money selling it once a week. Not even enough to get a single hit of heroin or one oxycodone. Methadone works by blocking your opiate receptors. So even if you do use, you don’t feel it, you don’t get high. Methadone has an extremely long half-life, meaning that if you miss a dose or two- 1) you don’t get sick 2) even if you do use you DON’T get high.

      But yeah, way to to be judgemental as fuck when you don’t know anything about how a clinic or how methadone works. Typical cop.

    • From the other perspective, being tied to a methadone clinic is incredibly time consuming, and long-term effects of the drug are not exactly spectacular. Finding a job that fits around the clinic’s schedule is not easy. Vivitrol is a monthly dose that is non-narcotic. I work in the field and I’ve been on Vivitrol and Suboxone (admittedly, not methadone, but it’s not available in my area). Vivitrol gives people their lives back, while methadone is more like doctor shopping. And I’ve worked with family members, sometimes an arrest can be a life saver to dry someone out long enough and get them the case management, insurance, and care that’s needed – usually with diversion programs so a record can be avoided. Methadone is better than heroin, Suboxone is generally considered a slightly more effective alternative, while vivitrol is quickly becoming the best option.

  • This has to be the most uniformed and biased article I have seen in a bit. You are right about patients having to detox prior to use, but Tom Price is correct. Methdaone and buprenorphine are both opiods, which are administered under controlled conditions; hence it really is swapping one opiod for another. I would think that abstinence as well as the means to deliver you to that are both important factors in recovery. By almost all accounts, Vivotrol does that, although the author seems to imply that perpetual addiction to a safer opiod is a more realistic route. I do recognize that the author works for Open Society Foundations, a Soros funded group. With that in mind, it is no surprise that the author attempts to discredit Vivotrol by trying to tie Trump to Putin. I applaud all commenters who know and call BS when they read it.

  • 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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