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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.

  • i have taken suboxone, methadone and vivitrol and i can tell you vivitrol is a game changer. i have gotten several friends to go on it to just try and they’ve all agreed w my sentiments. after a few times you find that you don’t even really need it bc you’ve stopped for so long and your whole mindset has changed-however it is there should you feel yourself slipping. it’s a shame that it is so expensive and not widely available to most people w the exception of a few programs. this takes away the cravings and the general mindset that forces you to always focus on drugs bc you know there’s no point and so eventually you stop even thinking about the drugs. plus it lasts so long it’s not a daily battle of should i or shouldn’t i skip my meds today-or in terms of methadone it just gets you higher when combined w heroin. the person who wrote this has no idea what they’re talking about (bc they’ve never had a dependency and needed any of these) or they do know better (and are purposely talking it down for whatever stake they have in this-i would say “game” however it is life and death and not a “game”. shame on the writer(s). also it’s odd isn’t it that bupe-in suboxone- is the one thing that can override vivitrol.

    • Seriously! I concur. This person is a bad actor commentator. They’re obviously benefitting from the bigpharma-boomboom-opioidepidemic-recoverydollar-market!
      I’m in it right now. This drug has seriously worked on me, and more than a handful of people I was recently in rehab with would tell you the same. I asked around before I put that in my body. I didn’t want to be a lab rat.
      Yeah, I still have some issues I need to get cleared up with my therapist. But that mental stuff is “just living”. This drug doesn’t make you feel like you’re “on” anything. You do stop craving emotionally. Your mind might still mess with you, but that’s why this drug is there!
      If you take a drink or 3 or 12, you don’t puke your guts out, you just can’t get buzzed or drunk! If you take an opioid, you aren’t going to feel any of the “high” (EUPHORIA). What you WILL feel are all the side effects; The sweats, dazed & confused, the apathy, the fatigue, the heart racing, did I mention the sweats!?
      But, you will feel NONE of the good stuff. Trust me, I tried. So, why bother!?
      Seriously, trust in this crap for as long as it takes for your brain to heal. Thankfully, on my second tour through rehab in one year, this time they recommended this once a month shot!
      But, me being a hardcore addict, I’m like a trial & error rat in a cage. I tried to get around it, it didn’t work at all. Not even 3-4 weeks after the shot. So I got my next one. Thankfully, I didn’t end up dead. I hope this helps someone else, and they won’t have to try crap out. But the beauty of the medicine is: it acts as it was intended.

  • Whoa sorry I understand and feel where your coming from and what it getting across to the public but how many milligrams are you on because ,I was on the whole 120or130 cant remember any more but for a whole year lol. Wow if ur content in ur mind with the methadone ayh on u but I did H on it everyday couldn’t pass a drop but I told um how I needed it just bullshiting to make my parents happy lol plus smoked dope and u and I both know that when u come off that shit just like suboxone ur going to be sicker than coming off dope, or any pharmaceuticals,besides the fentanyl patches…. So I’m really wondering if you can provide any factual information that would back up ur stories about the vivitrol and the harmful effects or how it could be harmful for the body ?????? Well idk I guess day by day for u buddy but whatever works I guess

  • I strongly suspect that the writer has never been on Methadone or anything like it. My personal experience leads me to think that Vivitrol might be an excellent alternative. Watch my sister start to nod off, standing up, a few hours after dosing Methadone and you might think so too.

    • I actually think this article is very informative and I wish people would actually look at the bigger picture! Speaking from experience, I am fortunate to have my life back after years of destructive & disgusting drug use, all thanks to methadone. There are some people who unfortunately abuse the program and do not report that their dose is causing them to nod off and sleep excessively. When all they need is an adjustment to their dose level. I know that it can be awful and frustrating to watch someone you love hurt themselves over and over. But to blame a medication that is proven to have been successful for so many others, is not okay. Vivitrol is a new drug and what scares me, is there are people in positions of authority who are administering this drug to people simply on claims from the maker of the drug. Not on actually documented facts! It is hurting people, not helping

    • The reason shes nodding is because shes abusing it, some patients on methadone go upto a high dose because they still want to nod and get high basically legally, so try to convince her she doesnt need that high of a dose to not have cravings or withdrawal, if she refuses to go down on her daily dose, then shes just getting high off the methadone intentionally and “ill get sick if i stop” is just a bs excuse, ive tapered 10mg per week down and felt NO withdrawals, surely she can go down 5 a week no problem. Also mixing benzodiazepines and some other drugs will cause the methadone to be more potent but can kill you quickly with the respiratory depression

  • Millions world-wide in 12 Step living the “fantasy” of being drug free. The drug dealers pushing methadone and suboxone are threatened by this, and by Vivitrol which is a viable strategy to being drug free. The lie is dead, we do recover. But drug dealers still going to push drugs as long as they can exploit addicts. This article is no better than the dope boy on the corner.

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