Vivitrol Treatment and How It Works

Vivitrol is administered through injections, although there’s also an oral equivalent called ReVia. (Vivitrol.com)

Some time back, we published a mother’s thoughts on medication assisted treatment (MAT), including the most common arguments both for and against this particular recovery tool and how it fits into the overall recovery process, especially the Florida Model of rehabilitation. While the article in question made note of the fact that MAT is not a “one size fits all” type of ordeal, there are still many patients who swear by it and claim that they would not have recovered successfully without it. We would never force a patient to undergo a process that did not appear to be working, but we would also not deny fully the opportunity to try a form of treatment which has worked for many. This is why Amethyst Recovery has decided to begin offering Vivitrol shots.

Vivitrol is a bit newer than methadone or Suboxone, two of the other most common drugs used in MAT. As such, we recognize that some prospective patients and families may not be fully aware of what it is, not to mention its effects and how it works. In fact, some might not even be aware of its existence. Hopefully, the following sections of this article will help to answer some of these very questions.

What Exactly Is Vivitrol?

Vivitrol comes in a little glass vial. It may be unassuming, but for some, it’s the start of a new life. (KABC-TV/DT)

Vivitrol, which is also known as naltrexone, is a relatively new medication that is often utilized in the treatment of patients who are addicted to opiates (although it may also be used in the treatment of alcoholics, as well). Vivitrol is generally given in the form of an injection, administered once every month while the addict undergoes a process of detox and recovery. Naturally, Vivitrol is often not used on its own. Opiate addicts and alcoholics who receive this medication will often be subjected to other recovery methods, such as cognitive behavioral therapy and 12-step meetings, although this will not be the case at all facilities which offer Vivitrol as a method of treatment.

There is also an oral medication known as ReVia. This is considered to be the more generic form of naltrexone, although both medications work in approximately the same manner. To be more specific, both medications are opioid antagonists. For those who are unfamiliar with this term, an opioid antagonist is a type of non-opioid medication that binds certain neural receptors to inhibit euphoria. In layman’s terms, opioid antagonists more or less shut off the brain’s ability to feel pleasure as a result of opiate use. It doesn’t matter whether the opiate in question is a medication such as morphine or hydrocodone, or even a hard drug such as heroin—with Vivitrol and ReVia, the addict will not derive pleasure from their drug of choice and will therefore find drug use to be a pointless endeavor.

This means that Vivitrol is actually quite different from other drugs used in MAT. Methadone is an opiate medication, not an opioid antagonist. And buprenorphine, known more commonly as Suboxone, is what is known as a partial opioid agonist. This means that the effects are not the same as those of major opiates, but they are not completely shut off as they are with an opioid antagonist such as Vivitrol. We are not saying that methadone and buprenorphine are incapable of helping addicts to recover, nor are we denying the fact that a fair number of opiate addicts have recovered using these forms of MAT. We are simply stating the fact that, in terms of sheer definition, Vivitrol stands apart.

Because Vivitrol is relatively new compared to other forms of MAT such as methadone, and because it has proved effective as an opioid antagonist, it has been highly sought after by some patients. The one thing about which many are unsure is why it seems to prove effective in the treatment of alcoholism. Even the website for Vivitrol itself expresses uncertainty, although they do posit a guess.

Their belief is that Vivitrol helps to combat alcohol addiction by blocking certain receptors in the brain. While the receptors blocked by Vivitrol are often associated with opiate use, some of them may also release endorphins when imbibing alcohol. By helping to block the pleasurable feelings associated with these forms of addiction, Vivitrol can help the addict or alcoholic to remain clean while they detoxify their systems and enter into a period of sobriety.

How Does Vivitrol Work?

A patient waits to receive a Vivitrol shot. (J.B. Forbes/St. Louis Post-Dispatch)

We’ve already talked a bit about how Vivitrol works as an opioid antagonist, blocking certain neural receptors associated with the use (or in this case, abuse) of drugs and alcohol. But this is only one side of the coin. To truly understand how Vivitrol works, we must also examine how it is used by treatment centers. It is not necessarily as simple as taking a single shot and hoping that the addict recovers. That would be reckless, and it is certainly not our policy here at Amethyst Recovery.

It is already our policy to ensure that our programs are somewhat personalized, to ensure the best and most effective recovery treatment for every patient that walks through our doors. Every individual has their own specific treatment needs, and Vivitrol does not present an exception to this rule. As previously mentioned, Vivitrol is used in conjunction with other proper recovery methods such as therapy, physical exercise, health care, etc. To understand more about Vivitrol, the best option would actually be to contact us with any questions that you may have. But what you need to know above all else is that the dosage of Vivitrol required, the length of treatment recommended, and the supporting forms of treatment used in conjunction with the medication will be concluded after careful consideration of the patient’s needs.

The reason that we do not believe Vivitrol to be enough of a recovery tool on its own is that there is no method by which it can help the addict to better understand the need for sobriety, nor can it combat any co-occurring disorders from which the patient may suffer. It cannot cure them of their legal troubles, and it cannot help them to understand the toll that addiction takes on them and the loving people who want to see them recover. What it can do, however, is help them to stave off cravings while they learn about their disease and how it has affected their life. It will increase their chances of abstention, thereby decreasing their chances of suffering from relapse, as the lack of cravings will make them less likely to fake their way through treatment.

The effects of the Vivitrol shot last for quite a while, which is why patients generally only need injections once every month during their treatment period. By the end of the month, the medication’s abilities to block opioid receptors in the brain will begin to wear off. This means that in-patient treatment, while not required, may be preferred so as to further present the risks of a relapse once the medication begins to lose its potency.

Those who receive out-patient treatment while receiving Vivitrol injections should wear some type of medical alert tag, or carry some sort of notification that they are on the medication. In the case of an emergency which results in the patient being transferred to a hospital while unconscious, it is important for the doctors to know that the patient should not receive any opiate medications if they can be avoided. While we would certainly hope that this situation does not arise, one can never be too careful.

Are There Any Side Effects?

The only particularly major side effect is relegated to cases of relapse. And even then, the experts are conflicting. (ShutterStock)

Both Vivitrol and ReVia are accompanied by certain side effects. The good news is that most of these side effects are relatively mild. The even greater news is that most of them do not last particularly long. Some of the most common side effects for ReVia include nausea, anxiety, headaches, sleep disruption, abdominal cramps and pain in the joints and muscles. The most common side effects for Vivitrol are more or less the same, although there have been uncommon occurrences of such side effects as gastrointestinal disruption, coughing, chills, loss of appetite and increase of thirst. In rare occasions, an allergic skin rash may also occur.

There are certain types of patients who are recommended against taking Vivitrol or ReVia. These include pregnant women and nursing mothers, as well as anyone who suffers from kidney disease. It is also strongly recommended (and sometimes required) that patients who wish to receive naltrexone in any form abstain for opiate use for at least seven days, preferably ten or even fourteen days. The reason for this is that using Vivitrol prior to detox can result in major withdrawal symptoms. These symptoms are not as exacerbated for patients who have alcohol in their systems, although it is still recommended that patients cease drinking at least a week before commencing treatment.

One of the better aspects of Vivitrol is that, while there may be a few side effects, addiction is not one of them. This is a fear that many people have with methadone. While methadone has worked for many patients, others have become addicted to the methadone in lieu of their previous drug of choice. This has caused some to question the merit of treating opiate addiction with an opiate medication, but this is not a fear that one must harbor when undergoing Vivitrol treatment.

The most extreme side effect of Vivitrol occurs primarily in the event of a relapse. After Vivitrol treatment has ceased, some patients may actually be more sensitive to the effects of opioids. While this indicates an effective detox, regression into previous addictive habits could lead to tragedy. If the patient suffers a relapse and attempts to use the same amount of their preferred drug that they were using prior to treatment (when they had a higher tolerance for it), they may risk becoming overdosing and falling into a comatose state. In the worst cases, this can result in death.

This underscores the necessity of therapy and other forms of treatment. Vivitrol may appear to be a miracle drug, but the threat of relapse is a real one. In a recent article discussing the legal issues encountered by many addicts, we noted that proper rehabilitation may statistically lower the likelihood of recidivism. When the threat of relapse includes possible death for those who try to return to their previous habits, it is more important than ever to ensure that those who receive Vivitrol are treated by other means as well. On the bright side, the risk of death is not as high with naltrexone as it is with some other drugs, and it is believed that relapse is much less likely for those who have received Vivitrol treatment.

Is Vivitrol Really Effective?

Vivitrol can be very effective, but these chairs shouldn’t be empty. Tools such as therapy and a strong support network are still needed as well. (123RF)

The link we’ve posted at the end of the section above should be a pretty good indicator as to how effective Vivitrol treatment can be. But hearing a few vague facts about the potential benefits of Vivitrol may not be enough for some people. And given how important it is to receive effective treatment when entering a rehabilitation facility, we can certainly understand the skepticism which will inevitably be felt by some. Luckily, one state has presented itself as something of a case study regarding the success of Vivitrol treatment.

We’ve talked about the growing epidemic of heroin and opiate use in states such as Maryland before. But for our current purposes, we’d like to look a few states to the northeast. To be more specific, we’d like to look at the very northeastern corner of the United States. For those who don’t have a map of the US on hand, we’re talking about Maine.

Dr. Mark Publicker, President of the Northeast Society of Addiction Medicine, says that Vivitrol is a “valuable addition” to the field of recovery. This quote comes from a report by the Bangor Daily News, which also cites graphs demonstrating that the use of Vivitrol treatment in the state of Maine rose steadily between 2011 and 2013, with a sharp spike between 2013 and 2014. They also note that opiate use in the state of Maine has approximately doubled over the past ten years or so, indicating that the state was in great need of treatment which could provide long-term viability.

Of course, Publicker did not shout nothing but praise. He pointed to the fact that the eradication of tolerance could prove dangerous, that those who want to relapse will sometimes relapse regardless of reduced cravings. While he stated that Vivitrol treatment “can be effective if done well,” he did not want to go too far and imply that Vivitrol is a miracle drug. His caution is stated quite eloquently by the Director of Outpatient Behavioral Health at Brunswick’s Mid Coast Hospital, Eric Haram: “The tendency is for people to really want to polarize the discussion, and say Vivitrol’s good, Suboxone’s bad. Or Suboxone’s good, methadone’s bad. The bottom line here is [that] you need the whole toolbox.”

Haram’s sentiment mirrors what we have said numerous times in the above paragraphs—while we stand by the use of Vivitrol treatment, and will offer it to anyone who we believe could benefit from its use, it is not a panacea. It will not cure anyone’s addiction 100%, but relapse prevention will be much likelier when Vivitrol treatment is coupled with other proper recovery tools such as therapeutic counseling. If you wanted to, you could probably make the choice to find a detox center that would gladly administer Vivitrol shots without requiring further treatment or counseling of any sort.

But if you come to Amethyst Recovery, we can ensure that Vivitrol treatment is packed with the other tools and services you need to stay sober and prevent the tragedy of relapse. So please, make your choice carefully. It could easily be a choice between life and death.