Enough of that, let's get to the heart of this particular post. I would like to dedicate this post to a pretty new method of treatment for opiate addiction. This new treatment method seems really interesting and almost like that miracle cure we all desperately wish would just suddenly appear. How many times have you guys wished your addiction (and any other problems for that matter) would just magically disappear and never return? I know I certainly have. Unfortunately it's not that easy and there isn't such a cure at this moment. Although, I wouldn't put it past man and science to one day really come up with something so insanely cool (seriously, some of the shit we have created is amazing). Anyways, the method of treatment I am going to be talking about here is Vivitrol.
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| The Vivitrol Shot |
To those who have not yet heard about Vivitrol or know little about it, let me explain. Vivitrol is a method of treatment for opiate addiction (and alcohol addiction as well) which comes in the form of an injection (shot). The injection is given usually once every 28 days or month and its main purpose is to help addicts remain clean by lowering the sense of cravings and wanting to use. The main ingredient in Vivitrol is Naltrexone and is something I will talk about later in this post. Some of the other things I want to discuss in this post include how Vivitrol works/is used, how successful it can be, some side effects/warnings of the drug, the process of a Vivitrol program, and whatever else I can throw at you guys. I have never used Vivitrol myself but have talked to about 4 or 5 people who are either currently on it or have used it as well as asking both my drug addiction consular and drug addiction doctor. Let's start out by talking about the makeup of Vivitrol and the history of the drug.
As already mentioned, Vivitrol's main ingredient is the drug Naltrexone. Naltrexone is classified as an opioid receptor antagonist and it should be noted that Naltrexone is not the same thing as Naloxone, which is often used to treat someone who is experiencing an opiate or heroin overdose. Naltrexone works well for opiate addicts as it can block the euphoric effects of an opiate taken to get high. Basically, when a patient is on the Vivitrol shot, they cannot get high or will at least have much more difficulty in getting high. Most people that I have talked to that have used the Vivitrol shot say that the thought that they can no longer get high makes them feel less likely to use as they feel it is pointless to spend money on not being able to get high or to get a shitty high. However, this is not say it takes away all cravings and that you can't get high or attempt to get high. I have actually had some people I know and friends of friends who have overdosed or even died by trying to get high off opiates or heroin while on the Vivitrol shot. What usually happens in these cases of people overdosing and sometimes dying is that they attempt to get high while on Vivitrol but are unsuccessful so they attempt to take more of whatever drug they are attempting to get high off. This often leads to them taking far to much and overdosing.
Vivitrol was initially used to help with alcohol dependence and was just recently approved by the FDA in 2010 in the form of the once a month shot for the use of helping with opiate addiction. Naltrexone has been studied far more for alcohol dependence than in treating opioid dependence and there are still some cloudy questions/concerns about the drug as of now. Naltrexone was approved for aiding with opioid dependence in 1984 (at that time not in once a month shot form) but hadn't really started to become popular until just recently. Members of the addiction community felt that a main advantage that the Vivitrol shot has over drugs such as Suboxone and Methadone is that the Vivitrol shot is needed to be taken only once a month rather than having to take a pill on a daily basis like you normally would if you were on a Suboxone or Methadone program. This way it is more convenient for the patient and lowers the risk of the patient being able to skip their dose if you wish to get high like some do with Suboxone or Methadone. In addition to the shot, Vivitrol also comes in the form of an implant which is implanted into the body and is needed to be replaced over a period of 1-4 months depending upon the situation. For this particular post, we will only be discussing Vivitrol in the form of the once a month shot.
It is stressed that Vivitrol be used along with a support network, counseling, and attending of AA/NA meetings. Vivitrol has proven quite successful in helping those who suffer from alcohol addiction but there is not yet enough feedback and information as to how successful it can be with treating opiate addiction. Similar to how one must detox themselves off of opiates to begin a Suboxone or Methadone program, the Vivitrol injection should not be given to patients who are currently still drinking alcohol, people who are still using opiates or street drugs, and people who have used any kind of opiates within the past 7-10 days. To get onto a Vivitrol program, your addiction doctor will require you to take several drug tests in order to ensure that you have no opiates or alcohol in your system before your first (and every other) shot. Similar to Suboxone and Methadone, patients who have not waited long enough since their last dose of alcohol or opiates risk going into precipitated withdrawals. This is why it is important to be upfront and honest with your doctors and support network and to talk to these people frequently. The great thing about the Vivitrol shot is that it is not addicting or habit forming like Suboxone, Methadone, and so many other drugs that are out there. You will not get withdrawals from stopping Vivitrol period. However, it is important to note that if you do stop Vivitrol treatment, you can continue getting cravings or urges depending upon the person and their situation.
Nora Volkow, M.D., Director of the National Institute on Drug Abuse (NIDA), stated the following about the use of Vivitrol in patients suffering from opiate and alcohol addiction:
“As a depot formulation, dosed monthly, Vivitrol obviates the daily need for patients to motivate themselves to stick to a treatment regimen - a formidable task, especially in the face of multiple triggers of craving and relapse. This new option increases the pharmaceutical choices for treating opioid addiction, and may be seen as advantageous by those unwilling to consider agonist or partial agonist approaches to treatment. NIDA is continuing to support research on Vivitrol's effectiveness in this country, including a focus on criminal justice involved populations transitioning back into the community.”
The following statement was issued by the FDA in regards to clinical studies of the Vivitrol shot and the success of it within these clinical studies:
"The phase 3 clinical study upon which the FDA granted approval for Vivitrol in treating opioid dependence had an enrollment of 250 patients and treated for six months. Primary outcome measures were percentage of weekly urine tests negative for opioids and length of study retention during the double-blind period. Alkermes presented positive results from this study at the American Psychiatric Association 2010 Annual Meeting in May 2010. The study met its primary efficacy endpoint and data showed that patients treated once-monthly with Vivitrol demonstrated statistically significant higher rates of opioid-free urine screens, compared to patients treated with a placebo, as measured by the cumulative distribution of clean urine screens."
I was very curious about Vivitrol myself after talking to some other opiate addicts and my consular so I decided to ask my addiction doctor about Vivitrol. As I have said before in other posts, I am currently on a Suboxone outpatient program after battling a 2 year addiction to the Oxycodone 30 mg pills (my daily habit was between 180-300 mg per day). The Suboxone has worked really well for me and I am now over 4 months clean off of the Oxycodone. However, I will eventually stop using the Suboxone one day after my tapering program is finished which has made me somewhat worried and concerned about how I will fare without the Suboxone when that day comes. This has made me to give the Vivitrol shot some thought as I think I may switch over to the shot after I finish my Suboxone program (for how long, I have no idea yet). When I asked my addiction doctor about the shot, she told me it has been quite successful in her patients and gave me a pamphlet about Vivitrol. Everything about the Vivitrol shot seemed great but one thing really stood out to me. Now I realize that nearly every medication out there comes with its own risks and side effects, but man did Vivitrol seem to have a lot. There were a lot of warnings about some of the side effects people can experience when on Vivitrol which began giving me second thoughts, especially with the small amount of information out there on the Vivitrol shot for use of opiate addiction. To sum things up a little quicker and makes things easier, I'm going to post below some of the side effects or risks involved with the Vivitrol shot as a method used to treat opiate addiction. I put it in blue front so you guys can tell what they say and what I am writing, here it is:
Before receiving naltrexone injection,
- tell your doctor and pharmacist if you are allergic to naltrexone, any other medications, carboxymethylcellulose (an ingredient in artificial tears and some medications), or polylactide-co-glycolide (PLG; an ingredient in some injected medications). Ask your doctor or pharmacist if you don't know if a medication you are allergic to contains carboxymethylcellulose or PLG.
- tell your doctor if you have taken any opiate medications including certain medications for diarrhea, cough, or pain; methadone (Dolophine); or buprenorphine (Buprenex, Subutex, in Suboxone) within the last 7 to 10 days. Ask your doctor if you are not sure if a medication you have taken is an opiate Also tell your doctor if you have used any opiate street drugs such as heroin within the last 7 to 10 days. Your doctor may order certain tests to see if you have recently taken any opiate medications or used street drugs. Your doctor will not give you naltrexone injection if you have recently taken an opiate medication or used street drug.
- do not take any opiate medications or use street drugs during your treatment with naltrexone injection. Naltrexone injection blocks the effects of opiate medications and street drugs. You may not feel the effects of these substances if you take or use them at low or normal doses at most times during your treatment. However, you may be more sensitive to the effects of these substances when it is almost time for you to receive a dose of naltrexone injection or if you miss a dose of naltrexone injection. You may experience an overdose if you take normal doses of opiate medications at these times, or if you take high doses of opiate medications or use street drugs at any time during your treatment with naltrexone. An opiate overdose may cause serious injury, coma (long-lasting unconscious state), or death. If you take or use opiate medications or street drugs during your treatment and you develop any of the following symptoms, call your doctor or seek emergency medical care immediately: difficulty breathing, slow, shallow breathing, faintness, dizziness, or confusion. Be sure that your family knows which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own.
- you should know that you may be more sensitive to the effects of opiate medications or street drugs after you finish your treatment with naltrexone injection. After you finish your treatment, tell any doctor who may prescribe medication for you that you were previously treated with naltrexone injection.
- tell your doctor what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have stopped taking opiates or using street drugs and are experiencing withdrawal symptoms such as anxiety, sleeplessness, yawning, fever, sweating, teary eyes, runny nose, goose bumps, shakiness, hot or cold flushes, muscle aches, muscle twitches, restlessness, nausea and vomiting, diarrhea, or stomach cramps, and if you have or have ever had bleeding problems such as hemophilia (a bleeding disorder in which the blood does not clot normally), a low number of platelets in your blood, depression, or kidney disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while receiving naltrexone injection, call your doctor.
- if you need medical treatment or surgery, including dental surgery, tell the doctor or dentist that you are receiving naltrexone injection. Wear or carry medical identification so that healthcare providers who treat you in an emergency will know that you are receiving naltrexone injection.
- you should know that naltrexone injection may make you feel dizzy or drowsy. Do not drive a car or operate machinery or do other dangerous activities until you know how this medication affects you.
- you should know that people who drink large amounts of alcohol or who use street drugs often become depressed and sometimes try to harm or kill themselves. Receiving naltrexone injection does not decrease the risk that you will try to harm yourself. You, your family, or your caregiver should call your doctor right away if you experience symptoms such as feelings of sadness, anxiousness, worthlessness, or helplessness, or thinking about harming or killing yourself or planning or trying to do so. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor right away if you are unable to seek treatment on your own.
- you should know that naltrexone injection is only helpful when it is used as part of an addiction treatment program. It is important that you attend all counseling sessions, support group meetings, education programs or other treatments recommended by your doctor.
- talk to your doctor about the risks and benefits of naltrexone injection before you receive your first dose. Naltrexone will remain in your body for about 1 month after you receive the injection and cannot be removed before this time.
What side effects can this medication cause?
Naltrexone injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:- nausea
- vomiting
- diarrhea
- stomach pain
- decreased appetite
- dry mouth
- headache
- difficulty falling asleep or staying asleep
- dizziness
- tiredness
- anxiety
- joint pain or stiffness
- muscle cramps
- weakness
- tenderness, redness, bruising, or itching at the injection site
Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:
- pain, hardness, swelling, lumps, blisters, open wounds, or a dark scab at the injection site
- coughing
- wheezing
- shortness of breath
- hives
- rash
- swelling of the eyes, face, mouth, lips, tongue, or throat
- hoarseness
- difficulty swallowing
- chest pain
Naltrexone injection may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.
Adverse Effects
The most common side effects reported with naltrexone are non-specific gastrointestinal complaints such as diarrhea and abdominal cramping.
Naltrexone has been reported to cause liver damage (when given at doses higher than recommended). It carries an FDA boxed warning for this potential rare side effect. Due to these reports, some physicians may check liver function tests prior to starting naltrexone, and periodically thereafter. Concerns for liver toxicity initially arose from a study of non-addicted obese patients receiving 300mg of naltrexone. Subsequent studies have suggested limited toxicity in other patient populations.
Naltrexone should not be started prior to several (typically 7-10) days of abstinence from opioids. This is due to the risk of acute opioid withdrawal if naltrexone is taken, as naltrexone will displace most opioids from their receptors. The time of abstinence may be shorter than 7 days, depending on the half-life of the specific opioid taken. Some physicians use a naloxone challenge to determine whether an individual has any opioids remaining. The challenge involves giving a test dose of naloxone and monitoring for opioid withdrawal. If withdrawal occurs, naltrexone should not be started.
It is important that one not attempt to use opioids while using naltrexone. Although naltrexone blocks the opioid receptor, it is possible to override this blockade with very high doses of opioids. However this is quite dangerous and may lead to opioid overdose, respiratory depression, and death. Similarly one will not show normal response to opioid pain medications when taking naltrexone. In a supervised medical setting pain relief is possible but may require higher than usual doses, and the individual should be closely monitored for respiratory depression. All individuals taking naltrexone are encouraged to keep a card or a note in their wallet in case of an injury or another medical emergency. This is to let medical personnel know that special procedures are required if opiate-based painkillers are to be used.
There has been some controversy regarding the use of opioid-receptor antagonists, such as naltrexone, in the long-term management of opioid dependence due to the effect of these agents in sensitizing the opioid receptors. That is, after therapy, the opioid receptors continue to have increased sensitivity for a period during which the patient is at increased risk of opioid overdose. This effect reinforces the necessity of monitoring of therapy and provision of patient support measures by medical practitioners.
As I have said before, I have no experience with the Vivitrol shot so I don't want to seem like I am either knocking it or praising it. I am simply trying to provide you guys with some information about this method of treatment. In my opinion, this option seems to have much promise and appears quite interesting but I would certainly feel more comfortable talking to/hearing from other people about the matter and being able to read more about it. Like always, talk to your doctor and support team before trying the Vivitrol shot or making any drastic moves. Most of the people I have talked to said that the Vivitrol shot works really well for them but nearly all of them said they knew someone or knew of someone who overdosed by taking to much of their drug of choice trying to get high while on the Vivitrol shot. I've also heard of this happening with people who are on Suboxone and Methadone as well as people who were clean after going cold turkey that relapsed and used too much of their drug of choice to achieve a high resulting in overdose. Like anything, be careful and smart my friends with whatever you do, these things really can happen to anyone and usually occur so unexpectedly.
For anyone who is interested in knowing more about Vivitrol, I have listed the link to their official website below:
http://www.vivitrol.com/isi?s_mcid=ps-awb-opd-ma-site
The following was taken from their website homepage and is related to what exactly Vivitrol is, who should take it, and once again warnings and possible side effects. You can see the full medication guide on the site if you wish, it is located at the bottom of the company's homepage on their website that I have listed above this paragraph. Once again, I'll put this information in blue front for you guys.
IMPORTANT SAFETY INFORMATION
WHAT IS VIVITROL?
VIVITROL® (naltrexone for extended-release suspension) is a prescription injectable medicine used to treat alcohol dependence, and to prevent relapse to opioid dependence, after opioid detoxification. You should stop drinking before starting VIVITROL. To be effective, treatment with VIVITROL must be used along with other alcoholism or drug recovery programs such as counseling. VIVITROL may not work for everyone. VIVITROL has not been studied in children under the age of 18 years.
WHO SHOULD NOT TAKE VIVITROL?
Do not take VIVITROL if you are using or have physical dependence on opioid street drugs, such as heroin, or opioid-containing medicine, such as prescription pain medicine. You must not take opioid-containing medicines or opioid street drugs for 7-10 days before you start taking VIVITROL. You should not take VIVITROL if you have opioid withdrawal symptoms or are allergic to VIVITROL or any of the ingredients in the liquid used to mix VIVITROL (diluent). Click here to read the full medication guide to find out more about opioid withdrawal symptoms and to see a complete list of ingredients in VIVITROL and the diluent.
SERIOUS SIDE EFFECTS
SEVERE REACTIONS AT THE SITE OF INJECTION
Some people on VIVITROL treatment have had severe reactions at the site of injection (injection site reactions), including tissue death (necrosis). Some of these injection site reactions have required surgery. Call your doctor right away if you have any of the following things happen at your injection site: intense pain, the area feels hard, large area of swelling, lumps, blisters, an open wound or dark scab.
LIVER DAMAGE OR HEPATITIS
Naltrexone, the active ingredient in VIVITROL, can cause liver damage (including liver failure) or hepatitis, if you take more than the recommended dose. Tell your doctor if you have any of the following symptoms of liver problems during treatment with VIVITROL: stomach area pain lasting more than a few days, dark urine, yellowing of the whites of your eyes, or tiredness. Your doctor may need to stop treating you with VIVITROL if you get signs or symptoms of a serious problem.
RISK OF OPIOID OVERDOSE
If you have used opioid-containing medicines or opioid street drugs in the past, you may be more sensitive to lower doses of opioids after VIVITROL treatment stops, when your next VIVITROL dose is due or if you miss a dose of VIVITROL. Using opioids in amounts you used before treatment with VIVITROL can lead to overdose and death. You may not feel the usual effects if you use or abuse heroin and other illegal (street) drugs while on VIVITROL. Do not take large amounts of opioids, including opioid-containing medicines, such as prescription pain pills, or heroin, to overcome effects of VIVITROL. This can lead to overdose including serious injury, coma, or death. You may not feel the usual effects of opioid-containing medicines including medicines for pain, cough and diarrhea while on VIVITROL. It is important that you tell your family and the people closest to you of this increased sensitivity to opioids and the risk of overdose. You or someone close to you should get emergency medical help right away if you: have trouble breathing; become very drowsy with slowed breathing; have slow, shallow breathing (little chest movement with breathing); feel faint, very dizzy, or have unusual symptoms.
SEVERE ALLERGIC PNEUMONIA
Some people on VIVITROL treatment have had severe allergic pneumonia. Call your doctor right away if you experience shortness of breath or coughing that does not go away. You may need to go to the hospital for treatment with antibiotic and steroid medicines.
SERIOUS ALLERGIC REACTIONS
Serious allergic reactions can happen during or soon after an injection of VIVITROL. Tell your doctor or get medical help right away if you have any of these symptoms of a serious allergic reaction: skin rash, swelling of your face, mouth or tongue, trouble breathing or wheezing, chest pain, feeling dizzy or faint.
OTHER POSSIBLE SIDE EFFECTS
VIVITROL can cause other serious side effects, such as depressed mood that can sometimes lead to suicide, suicidal thoughts and suicidal behavior. You should tell your family members and the people closest to you if you are taking VIVITROL. Call your doctor right away if you experience signs of depression. Click here to find out more about some symptoms of depression.Common side effects of VIVITROL include nausea, tiredness, headache, vomiting, decreased appetite, painful joints and muscle cramps. In addition, common side effects in people taking VIVITROL for opioid dependence also include cold symptoms, trouble sleeping, and toothache.
Call your doctor for medical advice about side effects. You are encouraged to report negative side effects to the FDA. Visit www.fda.gov/medwatch or call
1-800-FDA-1088.
I hope this information is helpful for you guys and can only recommend that if you choose to give Vivitrol a try to really talk it over with your doctors and support network. Don't be afraid to ask questions and don't shy away from doing your own research into the matter in addition.
I would also like to talk about how exactly you take the Vivitrol shot and the basic process of getting into and staying with a program that offers Vivitrol. Like Suboxone and Methadone, you must see a doctor who is licensed to offer Vivitrol and you will most likely have to submit to drug testing and meet with a doctor and/or consular on a regular basis. You do not take home the shot and give it to yourself, rather the doctor will be the person giving you the shot. The shot is injected into a person's buttocks. I have no idea how big the needle is or if its painful, or if you can get the shot anywhere else on your body. I also want to note that getting into a Vivitrol program can sometimes be expensive and challenging. Some insurances cover the costs better than others and some do not cover it all so be sure to ask your insurance provider about the shot. I have also heard of some programs and doctors willing to work with their patients in regards to costs and that you can sometimes get like discounts/coupons for treatment like they have for Suboxone programs. I'm not sure if there is a certain limit to the amount of people a doctor can prescribe Vivitrol to such as with Suboxone or Methadone, but it wouldn't surprise me if there was one. Therefore, be sure to do your research and to call around for programs offering the Vivitrol shot if you wish to try it. Also, be sure that you are aware and know of the requirements of the program and are willing to go by their rules.
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| How the Vivitrol shot is given |
A final thing I want to talk about is the Vivitrol Curve Chart, which is basically a chart that shows patients how Vivitrol in body slowly rises until it reaches a peaking point and than begins to drop. Some patients report being able to get high or that they begin to get urges/cravings before their next dose is due. Doctors believe that this is because the Vivitrol shot is beginning to wear off resulting in another dose being needed. This is why you must get the shot every 28 days or so. My doctor told me that sometimes he will prescribe patients a week supply of Naltrexone in the form of a traditional pill the last week before their next dose to help with this issue. This is also why going to meetings and/or getting support from a consular is important when you're on the Vivitrol shot as it will help with urges/cravings and remaining clean. Doctors may also give their patients a one week supply of the Naltrexone before they start their Vivitrol treatment to make sure the patient is OK to take the shot and doesn't have any bad reactions to the Naltrexone.
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| This graph shows how Naltrexone (Black) in the Vivitrol reaches a peak period then begins to decrease over time resulting in the individual needing to get their next dose. The Gray lines represent Naltrexone in the pill form which stays at a much steadier rate but must be taken on a daily basis. |
Another thing about Vivitrol to note is that it doesn't really help with withdrawals you would experience from stopping opiates all together. The Vivitrol is more for helping with the urges/cravings rather than for the withdrawals. Some people say it helps greatly while others say it is not that helpful proving once again that everyone is different and reacts differently to things. Around where I live, Vivitrol is real popular for helping people who have just came out of a Rehab or Detox program as well as people who have recently stopped using Suboxone or Methadone after they waited long enough to get the Vivitrol shot.
Here are some links to some articles or websites devoted to discussing the Vivitrol shot.
http://abcnews.go.com/Health/MindMoodNews/month-vivitrol-shot-opioid-addicts/story?id=11865152
http://www.emedicinehealth.com/drug-naltrexone_injection/article_em.htm
http://www.soberliving.com/specprograms/vivitrol-shot-opioid-opiate-oxycontin-heroin-methadone-addiction-rehab
http://www.npr.org/blogs/health/2010/10/13/130534315/vivitrol-once-a-month-drug-is-a-new-anti-addiction-option
http://www.drugfree.org/join-together/addiction/vivitrol-slowly-makes-its-way-into-opioid-dependence-treatment
http://www.stopoxy.com/vivitrol-suboxone-probuphine-addiction-implants
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm229109.htm
http://www.drug-rehabilitation.org/5_benefits_of_vivitrol.php
That's all the information I have for you guys and hope it helps. Talk to your doctors and support network about the Vivitrol shot if it is something you're interested in trying. This post is more for people looking to Vivitrol as a way of helping with opiate addiction rather than for drinking dependence. I would really like to hear what you guys think and know about this new method of treatment and if anyone has any experience with the Vivitrol shot to please feel free to comment and talk about it. I'll leave the rest up to you guys to comment and get some conversation going. Also, don't forgot to check out the new applications and to vote on the new poll listed below. Thanks.
I'm not too sure what my next post is going to be about so if you guys have any ideas, feel free to leave them in the comment section. Until next time my friends, take care, be careful, and be happy. Life is far to short to be living the ways we lived as addicts. There is so much more out there besides getting high and this is coming from someone who really loved getting high. Vivitrol is just one of the many methods to help treat opiate addiction so don't feel as if your options are limited. It is not the path you took to get sober, it is the fact that you are now sober that matters most. Keep seeing the light my friends.
Sincerely,
Seeingthelight
