HWN Suggests

Oh No! Not Naltrexone!

Naltrexone, also known by its brand name, Vivitrol, is an opioid antagonist that kicks opioids off of opioid receptor in the brain, not unlike naloxone. But thanks to a combination of overprescription, unscrupulous marketing practices and ubiquitous use over more effective alternatives, naltrexone is a very controversial drug. In fact, a common reaction is Oh no! Not naltrexone! Of course, naltrexone has some benefits and many people say their life has been saved by it. And at Narcotica, we don’t believe any drug is “bad” or “evil.” So where does this substance fit into the broader scheme of things? We’ve spoken about naltrexone many times on this show, but never this indepth before.

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Featured

  Vivitrol’s New and Controversial Role in Prisons

Despite the arguments for and against the drug, it’s important to remember that Vivitrol is not an immediate cure to opioid dependency. However, according to those who have used it, the drug does give people a fighting chance – providing them with the ability to think about something other than the overwhelming desire to get high.

 Antagonist

An investigative documentary by Fentanyl, Inc. author Ben Westhoff, about how a medicine that has helped countless people beat opioid and alcohol addictions got sidelined by junk science and big money interests. Ben Westhoff is an award-winning investigative reporter whose book Fentanyl, Inc. has been translated around the world. His directorial debut Antagonist is an investigation into the suppression of the addiction medicine naltrexone, which has helped countless people beat opioids and alcohol.

 Naltrexone as Opioid Treatment: Who Does It Work For, Besides Cops?

Why do people keep prescribing naltrexone for OUD? It isn’t safe for people with a tolerance to opioids. Or people who recently used opioids. Or people who recently stopped using opioids. Or people who might use opioids again.

Articles of Interest

A decades-old drug is helping people drink less alcohol—without giving it up completely

Naltrexone has long been used to treat alcohol use disorder. Now it’s gaining attention as a tool for people who want to cut back on drinking before it becomes a bigger health problem.

The Last Shot

Amid a surging opiate crisis, the maker of the anti-addiction drug Vivitrol skirted the usual sales channels. It found a captive market for its once-a-month injection in the criminal justice system.

Why a promising treatment for alcohol abuse is barely used

Naltrexone is not a cure-all. It doesn't work for everyone. And a range of studies have demonstrated mixed results on its effectiveness.

A Drugmaker Tries To Cash In On The Opioid Epidemic, One State Law At A Time

The drug is a monthly shot used to treat alcohol and opioid addiction and one of a handful of FDA-approved treatments for addiction to opioids such as pain relievers, heroin and fentanyl.

A Medicine That Blunts The Buzz Of Alcohol Can Help Drinkers Cut Back

So, how does naltrexone work? The drug seems to curb the euphoric and sedative effects of opiates in the brain. Alcohol is known to activate some of the same receptors in the brain that opioids do, and studies find that by tempering the pleasure from alcohol, naltrexone can help people drink less.

A new study found a big problem with a popular opioid addiction medication

A long-awaited study compared two opioid addiction treatments. There’s good and bad news.

Addiction Drug’s Side Effect: More Overdoses?

Researchers suggest people getting Vivitrol shots may be more susceptible to a fatal overdose if they halt the regimen early and resume using opiates.

Alkermes’ Vivitrol marketing and lobbying put it under gun; pharma says not fair

The flap is yet another instance of drugmakers attracting public and political scrutiny for their marketing efforts, with companies in the opioid and addiction field attracting more and more heat as lawmakers and the FDA take new steps to fight an epidemic of overdoses.

Binge Drinking May Be Curbed With a Pill

A recent study suggested the use of a decades-old medicine taken before imbibing could reduce the amount of alcohol consumed.

FDA blasts Alkermes for underselling the risks of opioid addiction drug Vivitrol

The company failed to sufficiently communicate the risk of overdose associated with Vivitrol, which is one of three FDA-approved medications used to treat opioid use disorder. While Vivitrol guards against opioid cravings and relapse for people in recovery from opioid addiction, it reduces opioid tolerance and leaves its users more vulnerable to opioid overdose for patients who relapse, even at comparatively low doses.

How Safe Is America’s Hottest Heroin Addiction Treatment?

Naltrexone, however, has a very different effect on the brain. “You’re completely blocking the limited, deficient amount of endorphins present, so [patients are] getting less than they might have if they weren’t on naltrexone, and they feel horrible,” Kreek said.

Long-Acting Injectable Naltrexone for the Management of Patients with Opioid Dependence

Opioid dependence is a condition with serious clinical ramifications. Treatment has focused on detoxification, agonist therapy with methadone or buprenorphine, or remission maintenance with the opioid antagonist, naltrexone. Treatment with oral naltrexone has been limited by poor treatment adherence and relapse. Studies with long-acting formulations have shown increased treatment adherence. Extended-release injectable naltrexone has been used for the treatment of alcohol dependence, and has recently received an indication for treatment of opioid dependence from the US Food and Drug Administration.

Long-awaited study finds monthly Vivitrol as effective as daily pill for opioid addiction

The largest head-to-head study to date between two leading drugs to treat opioid addiction has found them roughly equivalent — an outcome that could dramatically change prescribing habits and boost the fortunes of the newer drug, Vivitrol. The study, sponsored by the National Institute on Drug Abuse, found that a monthly shot of naltrexone (sold as Vivitrol) is as effective as its main competitor, the daily pill of buprenorphine and naloxone (sold as Suboxone). Researchers found that about half of people with opioid addiction who took either drug remained free from relapse six months later.

Naltrexone long-acting formulation in the treatment of alcohol dependence

While oral naltrexone has a demonstrated ability to decrease alcohol reinforcement, it also has pharmacotherapeutic limitations, such as a small treatment effect size, adverse events, and plasma level fluctuations. The pharmacokinetic profile of naltrexone could be enhanced by intramuscular administration, which would sustain its release over several weeks and keep plasma levels relatively constant, ie, low enough to minimize side effects but high enough to reduce drinking.

Seizing on Opioid Crisis, a Drug Maker Lobbies Hard for Its Product

Alkermes executives say they welcome any addiction treatment. But in pitches to investors, doctors, law enforcement officials and legislators, they have presented Vivitrol as something of a miracle drug, a cleaner alternative to Suboxone, the most common formulation of buprenorphine. They described Suboxone as an addictive “black market” or “street” drug, emphasizing that it is smuggled into prisons.

Suboxone vs. Vivitrol: A Head-to-Head Comparison

Suboxone and Vivitrol both may help reduce craving and protect against relapse. Vivitrol, however, may be harder to start as it requires a period of at least a few days of opioid abstinence. If choosing between one or the other to reduce opioid use: Suboxone is the better choice in outpatient settings, while Suboxone and Vivitrol will fare similarly, on average, in an inpatient setting, where programs have the benefit of an extended detoxification if needed. These medications are not cure-alls – more than half of individuals relapsed during the 6 month trial, so more research is needed on clinical and recovery support services that can be integrated with these medications to improve outcomes.

Vivitrol, Used to Fight Opioid Misuse, Has a Major Overdose Problem

A recent examination of Vivitrol’s clinical trial data uncovered many hidden overdoses. Its preferential use in the criminal justice system must stop. Vivitrol, however, stops tolerance. While it protects people from overdose by blocking the biochemistry that opioid receptors initiate, this protection may decline during the last week before their next monthly shot. Vivitrol may also sensitize opioid receptors because the system reacts to having less opioid activity when they are blocked. These sensitized receptors may make relapse even more dangerous than after abstinence or other meds.

Resources

Antagonist documentary

Antagonist is a documentary about the opioid treatment drug naltrexone