Medication-assisted treatment, or MAT, is a general term used for addiction treatment plans that include a medical intervention along with counseling and support services. The most successful programs are those in which the medicine reduces or eliminates cravings, blocks the effects of the addiction substance, and includes wrap-around services to help the addict change behaviors, and in some cases environments, to have a successful long-term recovery.
Isn’t MAT just trading a drug for a drug?
The point of MAT is to change abuse into recovery. Substances such as alcohol and opioids are dangerous for several reasons: they create a biochemical need in the brain (cravings); the body can build up tolerance, creating a runaway spiral of dosages needed to get high; and, particularly for street drugs, contaminates – either intentionally or unintentionally added – increase the risk of adverse reactions, including death. Medications used in MAT are controlled for dosage, for purity, and have been engineered to minimize side effects, although they can occur. There’s a huge difference between using illicit drugs or alcohol to try to satisfy runaway cravings or avoid the pain of withdrawal, and using medicines under the supervision of a doctor.
I’m hearing a lot about Narcan – is that the same thing as Vivitrol?
No, but they have interesting similarities and differences. Narcan is a trade name of the drug naloxone. It is used as an emergency response to opioid overdose when the patient is in imminent risk of dying. Vivitrol is an injectable, time-release version of naltrexone. While both drugs counter the effects of opioids, Vivitrol is designed for dependence treatment over a longer time period. Administering either drug to a person under the influence of opioids will immediately trigger withdrawal symptoms. In some communities, doses of Narcan are carried by law enforcement officers, or are even made available to families of addicts for use in overdose emergencies. In most areas, Narcan is administered by emergency medical responders.
Opioids, opiates – what’s the difference?
The terms derive from the opium poppy. Generally, opiates are drugs derived from the plant, such as opium, morphine, codeine and heroin. Opioids are the larger class of narcotic drugs that also include synthetic and semi-synthetic formulations, such as oxycodone, hydrocodone and others. Medically, opioids are primarily used for pain management. Prolonged use, over-dosing and genetic factors contribute to addiction and abuse of opioids. Cessation of use, especially in those addicted, can cause painful and debilitating withdrawal symptoms.
Does Vivitrol cure alcohol and opioid addictions?
There are no cures for addiction, but recovery is possible. Vivitrol can reduce or eliminate the “cravings” for alcohol that enable persons in recovery to concentrate on making the lifestyle and cognitive changes to stay in recovery and reduce the likelihood of relapse. For treatment of opioid addiction, naltrexone suppresses the euphoric effect of the drugs but patients report varying effect on opioid cravings. However, in either case, recovery is a process, and highly individualized.
Is it really more effective than just getting into a program?
The science says yes, at least for many people. Research is ongoing, and some early studies appear to show response differences between those with a particular genetic characteristic and those without. For those who respond well to Vivitrol, the monthly-administered dose increases compliance, encourages sobriety and can provide the “mental space” for counseling and support services to make long-term changes in lifestyle.
Are there any dangers to using Vivitrol?
Because naltrexone is an opioid receptor agonist – countering the effects of opioids in the brain – if there are opioids in the system when naltrexone is administered it will trigger rapid and sometimes severe withdrawal symptoms. Some users try to overcome the “Vivitrol wall” by ingesting high doses of alcohol or opioids, leading to overdose and sometimes death. And tolerance can get reset while undergoing Vivitrol treatment, so those who do relapse often go back to their previous dosing, again leading to overdose. A related issue is that because Vivitrol (or the pill-form naltrexone) blocks opiate receptors, in case of medical emergency, opioid painkillers will be ineffective. There are a few reports of injection-site reactions and other side effects.
Haven’t we been down this road before with methadone and Suboxone?
Methadone and Suboxone are among the medications used to treat addictions. Methadone is a synthetic opioid that has been used to treat opioid addiction by lessening withdrawal symptoms, or in some cases blocking the euphoric effects of heroin or other opiates. Suboxone, a combination of buprenorphine and naloxone (see Narcan), is also used to treat opiate addiction. To generalize, methadone is a long-term opioid replacement, and Suboxone (specifically the buprenorphine component) is designed for shorter-term treatments. As “replacement” therapies, they can be thought of similarly to nicotine patches to help smokers “step down” and eventually stop smoking. Methadone can itself be addicting, and Suboxone in tablet form can be abused. Generally, methadone must be dispensed and ingested immediately, usually daily as a liquid in a clinic setting. Suboxone is a “sublingual” (under the tongue) tablet taken daily. Missing doses of either can lead to relapse, and Suboxone can be diverted to street use.
How is Vivitrol different?
Because Vivitrol is injected once a month, the medication cannot be diverted to street use. Even if it were, naltrexone is not addictive, and does not create the highs or dangerous effects. The daily pill form of naltrexone is effective, but requires compliance by the patient.
So why isn’t Vivitrol more widely available?
At least three barriers prevent Vivitrol from being more widely used to treat addiction: philosophical, institutional, and financial. There are still many policymakers who disapprove of so-called “replacement” treatments as trading one addiction for another. In some cases, previous treatments have been oversold and have created their own unanticipated problems. However, each new generation of opioid treatment drugs addresses the shortcomings of the previous ones, and science backs the combination of medication and counseling over either treatment method alone. Institutionally, it takes time to adapt service systems to incorporate new treatments. The Tri-County Board is working with its treatment providers to recruit area primary care physicians to prescribe and administer Vivitrol, and with courts and jails to get access to treatments before re-entry. Finally, at least for now, Vivitrol is expensive. Many public and private insurance plans cover the cost of Vivitrol and naltrexone, but do require pre-authorization. Check with the provider to determine eligibility.