The Other Opioid Dependence Medication

Today I met with representatives from Alkermes who were promoting Vivitrol, a long-acting mu opioid antagonist that is indicated for treatment of alcoholism and opioid dependence.

Naltrexone
Naltrexone

I admit to some pre-existing bias against the medication.  I’m not certain, to be honest, whether that bias was based upon sound clinical reasoning, or whether it was based on personal, negative reactions to naltrexone in my past.  Or maybe, as a recovering opioid addict, I have negative feelings about anything that blocks mu receptors!

Vivitrol consists of naltrexone in a long-acting matrix that is injected into the gluteal muscle each month. The medication is expensive, costing about $1000 per dose (!)  That cost is usually covered by insurance, and like with Suboxone, Wisconsin Medicaid picks up the tab save for a $3 copay.  Alkermes, the company that makes Vivitrol, also has a number of discounts available to reduce or even eliminate any copays required by insurance companies.

I’ll leave the indication of Vivitrol for alcoholism for another post.  The indication for opioid dependence came more recently, and appears more obvious, given the actions of naltrexone at the mu opioid receptor.

In short, naltrexone blocks the site where opioids—drugs like oxycodone, heroin, and methadone—have the majority of their actions.  Blockade of that site prevents opioids from having any clinical effect.  There is some dose, of course, where an agonist would regain actions— an important feature in the case of surgery or injury.  But even in those high doses, the euphoric effects of addictive opioids would be muted.  People on Vivitrol, essentially, are prevented from getting high from opioids.

Need a Suboxone Doctor? Cap Problems? ACT!

There are ongoing efforts to eliminate the cap on treating people for opioid dependence with buprenorphine or Suboxone.  I don’t know what the odds of success are, but the efforts would benefit from public demand.  If you have had difficulty finding a doctor with room under the cap, write a letter or email that explains just how important the issue is to you, and send it to the address(es) below.

The change requires an Act of Congress, or perhaps an executive order from someone high-placed in the Dept of Health and Human Services.  Consider sending a ‘cc’ to your elected representatives in the Senate or House of Representatives.  I am not excited about using NAABT.org, since they tend to be patsies for Reckitt-Benckiser (I’ve asked to have a link to this blog, or to our 6000-member forum on their web page, but they won’t– but they link to an R-B – supported forum instead– draw your own conclusions).  But this issue is too important even for my own righteous anger to get in the way!

Send comments to the following e-mail or mailing address:

NAABT, Inc.
P.O. Box 333
Farmington, CT 06034

Email address:
MakeContact@naabt.org

Questions and Answers about Opioid Dependence and Buprenorphine