Vivitrol & Revia Curb Opioid and Alcohol Addiction – Should be OTC?
What is there was a wonder drug that could effectively block the receptors in the brain that respond positively to the effects of prescription opioids and heroin? Sound crazy? Nope, it exists.
There’s no question about it – opiate abuse is operating at epidemic proportions in the United States. According to the Centers for Disease Control and Prevention, 259 million prescriptions for painkilling opioids were written in 2012. That was enough to put one bottle of pills in the hands of almost every American.
Over the last few years, prescription drug monitoring programs have popped up in most states. Use is haphazard, however – some states have regulations which require use, and others do not. Updating isn’t always in real-time. So these programs are imperfect, as are most systems.
For those who received prescriptions, there’s a real danger to losing them. Being pulled out from under a brain-altering substance has its consequences – namely, the addiction doesn’t go away because there is a lack of access to the substance. Many of these people turn to street drugs such as heroin, which has additional health risks associated with it.
Sadly, many addicts never get to treatment. Much of the time, they just don’t know where to turn. Long-term rehab can be expensive, and without insurance, it may be cost prohibitive.
Of note, however, many of the addicted are now working persons in the suburbs, thanks to the prescription opioid fallout. And with Obamacare, it’s possible that many more are now able to obtain the treatment they need.
Treatment is important because it helps the patient gather insights about their addiction. It teaches them how to identify triggers, and engage coping mechanisms. However, it doesn’t erase the changes made in the brain. There’s many components to addiction – biological, social, and emotional. And it’s the chemical aspect of opioids (and alcohol) that keeps the user coming back for more.
Moreover, I don’t care how messed up you are, you won’t be getting addicted to say, fish oil supplements. I don’t care how much you take, it just won’t activate that part of the brain.
What is Vivitrol (Naltrexone) and How Does it Work?
Vivitrol (naltrexone) is an antagonist drug which blocks opiates but does not activate the receptor. This is important because the lack of activation means there is no chance of dependence or tolerance. With little exception, this drug is safe and free from major side effects, including addiction.
Vivitrol also a “partial inverse agonist” which basically means that it creates an opposite effect to another agonist (in this case, opioids or alcohol.
If you ever learned about classical conditioning in psychology class and the famous experiment by Ivan Pavlov, you might understand how this works. In his experiments, he trained a dog to salivate after hearing a bell ring, by offering him food each time he heard the bell.
That’s a lot like how addiction works in our brains. Antagonist drugs like Vivitrol are essentially the equivalent of kicking the dog in the teeth after he hear the bells. No more salivating. That’s how powerful and helpful this drug can be.
To be clear, naltrexone is related to, but not the same as Narcan (naloxone) which is used primarily (and very successfully) in cases of overdose to reverse the effects. Naloxone has been in the news a lot lately, due to the many lives saved from opiate overdose.
Naltrexone is also commonly known by the brand name Revia.
Vivitrol is essentially naltrexone as a time-released injectable. There is a real benefit to this method – once injected, there’s no going back. As a pill, a user can opt not to take it on any give day, as with naltrexone as oral suspension. Once it’s injected, you are looking at up to a month of opioid antagonism.
Vivitrol’s website (http://www.vivitrol.com) has information about finding providers. Those who offer Vivitrol are usually drug and alcohol recovery centers, which ensures the patient receives treatment along with the medication.
Vivitrol and injections aside, my current thinking is that naltrexone should be available as an over-the-counter drug. After all, CVS has done this with the similar drug naloxone in 14 states. There’s a lot of debate about whether naloxone really should be over-the-counter. I researched but didn’t see any similar argument for Revia, and I wonder why. It does seem like this idea would fall firmly under a harm reduction philosophy and overall public health approach.
Here’s my reasoning: Yes, one should absolutely engage in treatment while fighting an addiction. But for those who just can’t or won’t do it, for whatever reason – wouldn’t it still be better for them to have access to this drug? To have a chance at getting sober, despite the lack of insight into their addiction?
From all accounts, naltrexone is very effective with no chance for dependency. So why not? Why not let people try it? Even if it doesn’t erase the emotional reasons why we become addicts, it may still prevent someone from using. Why would we withhold it from them? If there is a medical reason for it, I’d like to know.
~ G. Nathalee Serrels, M.A., Psychology