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What You Should Know About Vivitrol And Addiction Treatment

    Opioid antagonist - HCP-Administered (in office as outpatient visit) - Once-monthly injectable - Used with counseling - Non-addictive - Has no street value - Non-narcotic - Requires detox assistance with available if necessary

As the science of addiction medicine evolves, doctors have begun using new drugs in revolutionary ways that are changing how we think of and treat addiction.  Vivitrol is a drug used to treat both opioid addiction as well as alcoholism.  Since 2006, when it was first approved by the FDA for alcoholism, many patients have shown much success.  In October 2010, this injectable form of naltrexone was approved to treat opioid addiction as well.  It has since been used successfully by many with addiction to opiates and heroin.

What should you know about Vivitrol and it use in addiction treatment?

What Is Vivitrol?  Vivitrol is an extended-release injectable version of naltrexone that is given once a month.  It is known as an opiate antagonist, meaning it works by binding with and blocking the receptor sites in the brain that would normally be affected by opiates or alcohol.

How Does Vivitrol Work?  Unlike an opiate agonist, the opiate antagonist occupies the receptor site but does not activate the receptor.  This means that the site is tied up without the person feeling the “high” that would come with using a drug that activates the site.  Because the receptors are tied up, when someone on Vivitrol uses alcohol or opiates, they do not feel the pleasurable effects of intoxication.

How Is Vivitrol Different From Naltrexone?  Naltrexone requires a daily oral dose and has been used for years in addiction treatment  There are two main downsides to this self-administered daily dose:  1) it is easy for patients to forget the daily dose,  and patients who forget to take the medication are at a greater risk of relapse; and 2) there is a daily temptation to skip the dose for that day,  in order to drink or use or even to have the possibility to drink or use.

Vivitrol largely eliminates these issues.  It is a monthly shot administered by a health professional.  Its effects last for a full 30 days.   Two main benefits to the monthly shot versus daily tablets:  1) medical professionals can monitor a patient’s compliance and remind the patient when the next dose is needed.  Patients have someone to be accountable to and someone who will be talking with them if they are being tempted to use.  2) Patients are freed from the daily decision to take the dose or not and so there is no daily temptation to use.  Many patients report they have a greater peace of mind knowing there is no possibility to use.  (Actually they could use, but it would have no or very little effect on them.)

Pros of Vivitrol Use:

  • There are many benefits to using Vivitrol under the care of an addictions medicine specialist.  Vivitrol appeals to many doctors and patients alike, who do not wish to treat an opioid addiction with another opioid medication (also known as agonist treatment).
  • For individuals who have not been heavily addicted for more than a year and the brain has likely not been radically changed by drug abuse, Vivitrol is an ideal tool to use in early recovery.
  • Vivitrol drastically reduces cravings for opiates and alcohol.
  • For some, using Vivitrol while actively engaged in counseling and self-help groups such as AA, NA or SMART Recovery results in lasting sobriety, even after Vivitrol is discontinued.
  • Vivitrol is an ideal choice for patients coming off of methadone or buprenorphine (maintenance drugs) especially in the first few months, when they are at greater risk for relapse.
  • For those that work in jobs with frequent travel, such as pilots, business consultants, flight attendants, Vivitrol is appealing because it is a safe, supervised method of treatment that does not require daily dosing.

Cons of Vivitrol Use:

  • Potential side effects
  • Perhaps the biggest con to Vivitrol is its cost.  Unless one has private insurance that covers prescription drugs well, Vivitrol is very expensive.  The shot can run up to $1200 per month (even higher in some cases).  Even with insurance, co pays and deductibles can leave a patient paying quite a bit on a monthly basis.  The company that makes the drug offers patients up to $500 to cover co pays or off the cost of the shot for those without insurance.  Even with this financial assistance, Vivitrol can be quite expensive.
  • Another drawback of Vivitrol is that patients can only get started on the drug after all alcohol and opiates are out of the patient’s system.  Generally this means that the patient has gone through detoxification and has been sober and clean for 7-10 days.  This usually only occurs when the patient is an inpatient program or a hospital setting.
  • Also, Vivitrol is currently only FDA approved for those 18 and older, although it is used “off label” for younger patients successfully and safely.
  • Finally, as with all prescription drugs, there are side effects.

Individual Decision

Vivitrol has many advantages and several disadvantages.  It is important for patients and healthcare professionals to understand the full picture when considering Vivitrol for substance abuse treatment.  The decision whether or not to take a drug like Vivitrol is an individual, case by case decision and should be made with a doctor who is properly credentialed.  If the decision is made to use Vivitrol, it should be done in conjunction with formal treatment and/or individual or group counseling for the best results.


Common questions with the answers

How Long do I wear the device?

The device should be left on for the period of time recommended by you treating clinician.  The device is designed to provide neuro-modulating signals for 96 hours over 4-5 days

How many treatments will I need?

The BRIDGE is designed for a single use, for ACUTE pain.  In rare situations a second device may need to be placed.  Please discuss with your provider.

How soon will I see results from the treatment?

Acute pain will begin to diminish significantly in less than 30 minutes in most cases.

What if my pain returns?

If you begin to feel increased pain, that is significant, the more likely reason is your needle implants have become loose.  Do the “pinch test” to reset them.  You may need to place new circle bandages in some situations,  If after you have done this and waited 15 minutes, and your pain persists, contact your provider.  Your provider may have non-narcotic medications that will assist you.

What if I don’t feel the pulsing? Should I take the device off?

No.  Your body will become attenuated or “used to” the pulsing so you may not always feel it.  Just because you don’t feel it does NOT mean it isn’t working.  If you have questions call your provider and discuss this with them.

What if my ear starts hurting during treatment?

On rare occasions a patient may feel a stinging sensation where the electrodes are implanted.  This is only a sensation and you will not get burned.  If this happens, a gentle squeeze with your fingers (pinch Test) will help take care of the problem.  If your try this and the pain continues please call your treatment provider

Are there any normal precautions?

Yes, You need to take special care to not get the device wet while showering or washing your hair.  Do not go swimming with the device in place.  Do not immerse in water.  It is an extremely safe, water resistant, low voltage electronic device that will simply stop working in the batteries get wet.  And NO, you won’t get shocked if it’s get

How do I keep from getting the device wet when showering?

Holding a dry washcloth over the device while showering or washing your hair works very well.  We’ve also had patients tell us they use a small empty margarine bowl with a dry clothe inside to hold over the device.

Are there any side effects?

Skin irritation, Bleeding or infection at the site of implantations, Pain at the site of implantation, A sore ear, Allergic reactions to the tape and adhesive, Dizziness, and Fainting

Once the device treatment is over what do I do with the device?

Place the device in waste bag provided by your treating clinician Bring the waste bag containing the used device with you to your next treatment dates. The clinician will properly dispose of it.

We hope we have addressed any questions you may have about your treatment and what to expect.  If you have any further questions please be sure to ask your healthcare provider.