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Vivitrol is an injectable form of naltrexone that is FDA approved for treating opioid overuse disorder and alcohol overuse disorder, to be used "as part of a comprehensive management program that includes psychological support."*

Vivitrol is a once a month shot. It blocks the opioid receptor and then even if an opioid is taken, there is no effect. Naltrexone holds on to the receptor more tightly than morphine, heroin, codeine, and then buprenorphine.

I have offered this to long time suboxone patients, but no takers yet. UW Medicine has a detox center where people can go inpatient, have support for the withdrawal from suboxone and then get the Vivitrol. The withdrawal takes a week. The FDA information says 7-14 days...

I called the detox center when I had two under age 20 patients relapse from suboxone to heroin. I was feeling major failure. The physician that runs it said, "Yeah, we're not using suboxone much for the under 25 year old folks. We've switched. Instead, when we have them in detox, we support withdrawal and offer a Vivitrol shot. Most of them will not follow up for the next one, but at least they have a month clean."

The under age 25 has to do with brain maturity. The brain starts remyelinating at puberty, back to front, ending with the frontal lobes at around age 25. The brain still changes after that and can remodel and heal, but that's major change period. Pot studies on teens show that marijuana slows the myelination of the brain. When teens stopped marijuana for a month, their brains picked up the rate of myelination and started paralleling the myelination of non-drug using peers. Addictive drugs, at least marijuana and alcohol and opioids, slow brain maturation. And the frontal lobes are used for delaying gratification, deciding not to do risky things, long term planning. Hmmmm. The younger the addictive drug use and more drugs used, the less the brain matures.

I don't have an inpatient facility locally, but I can offer direction and help. I can also help them with calling the insurance and getting prior authorization and getting a bed and all of that, but I am not seeing the young ones much. We have some additional options in town recently and apparently the hospital got a grant to train multiple providers in suboxone. They've done it, but want to treat people as part of their family practice and med-peds practices. It can be done, because I do, but I think it would be very very difficult to do it in 20 minute visits with no experience. I don't know if the hospital "system" gives more time for that.

I went through a Vivitrol training with a physician who works with patients to get them off their opioid and on to suboxone. He said it takes them 3 months to 3 years to clean up whatever mess their life is in. Then he switches them to Vivitrol. After a year of Vivitrol they can go off it: no withdrawal at all.

Blocking the receptor keeps the person from any effect of "using" opioids, but the blockade also reduces the craving.

Vivitrol is currently really expensive. Down from $700 a month to more like $400 and more insurances are covering it. There is oral naltrexone too, but that is trickier, to avoid temptation and take it daily.

The comprehensive psychological support means AA or NA or intensive outpatient drug treatment or the mindful version of AA/NA where you don't need a higher power. I have surveyed many of my local counselors, and most of them say that they do not have addiction training. There are a few that have excellent training and experience. Our intensive outpatient was very uncomfortable with MAT ("medication assisted treatment") for opioid overuse disorder at first, but opioids are different than alcohol. Many many alcoholics can get dry. With heroin and opioids, people can relapse after years and years clean. The rate of relapse is worse and the deaths are faster and younger. MAT is now increasingly the standard of care.

*FDA information on Vivitrol

a rehab opinion

prescribing insert

Iron Noder: Tokyo drift 21

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