Does Vivitrol work? This is a legitimate question

[Former addicts mom]

I ran across this board doing a google search for vivitrol. In answer to the original question, YES it does work. My daughter is close to a year now of being free of her heroin addiction and I can honestly say if it weren't for vivitrol I doubt she would be alive today. It isn't a miracle in a shot; what it has done for her is:
~Completely remove her cravings
~Allowed her to have a clear head to make the choices she needs to make to move forward with her life and her recovery
~Given her the knowledge that using heroin would not give her the euphoria it once used to

She has gone through rehab 4-5 times and succumbed to the call of heroin every time she was released. She had tried suboxone and methadone; both were almost as bad as the heroin they replaced. Naltrexone in the pill form would have the same effect at a much lower cost, but expecting an addict to take their meds on a regular basis is unrealistic. It would be great if they would but it just won't happen. With the shot, taking as prescribed becomes a non issue. Vivitrol allows them time... sane time to do what they need to do to get off the cycle of addiction and out of the revolving rehab door.

Is it expensive? Yes it is very expensive. Luckily we have good prescription coverage, but even if we didn't her life is worth more than the monthly cost of her shot. As far as studies, I don't need to read statistics to know that this medication works; that it can save hundreds or thousands of lives... all I have to do is look at my daughter's face; see her living a productive life for the first time in 6 years and I know it is a good product that works the way it is advertised, better in fact.

 

[Anonymous]

My Response-My clinical experience has led to me not believing in the use of medications. I have seen and treated the addiction themselves, the process addictions, and also the addictions to doctors/attention/and any med not just the mind altering meds. The whole mentality around medication, and needing to change something wrong within us by the use of medications is a problem as great as the DOC. It’s that mentality that must change. Why would a medical profession reinforce destructive thought patterns?
A: As I stated previously, one either believes in MAT or they don't. Our personal experiences have led us down different paths - fair enough. Since there's more than one way to treat addiction, there is no gold standard - leaving us to rely on clinical judgement.


My Response-Vivitrol doesn’t reduce cravings, that we know by experience. It blocks addicts ability to get high, at least for a portion of the month. But, we both know it doesn’t work for as long as the Vivitrol reps tell us it works. And in that lies a problem. Addicts know this, and begin pushing on those receptors. And in order to test those receptors many are tempted to push opiates past their comfortable boundaries chasing a high. No amount of education will change that behavior in most addicts. Also, what we know is if you block an addicts ability to get high from their DOC, they merely switch DOC or stop taking the Vivitrol. It’s a big 800 dollar what’s the point.
A: You've observed a lack of decreased cravings while I have observed the opposite. Admittedly, craving reduction in alcoholics appears to be less pronounced than in opiate addicts.
I can't comment on what your vivitrol rep tells you but I think we may share a similar outlook on pharma reps in general.
I have had pts complain about the cravings returning towards the end of the 30-day period. (which, btw, proves the vivitrol *did* decrease the cravings for some period of time). It hard to decipher the truth at times. One approach is to give them a script for oral nltx and tell them to take as needed, but no more than 1 per day.
It's true that some will change their DOC but I see that dynamic more often in those using stimulants than depressants.
You might want to get your rep back in. Vivitrol has some financial support that reduces the cost.



My Response-So you acknowledge that an addict will need to be anesthetized in order to gain pain relief beyond COX-2’s. That is even in cases where a patient would not have needed anesthesia normally.
A: No. My point was that *everybody* is going to receive general anesthesia in the scenario you offered. I recognize that OD patients have a lower threshold, in general, than sober pts and that they will not be able to receive relief via opiates as long as the NLTX is on board.



My Response-You make some terrific points about exit strategies. I have more respect for addiction medicine physicians who actually acknowledge the need for chemical free sobriety. We might disagree on how to get there, but at least we are moving towards the same goal. I can accept that.
A: Agreed. And the lack of an opiate is an attraction for me to vivitrol. Pts don't suffer physical withdrawals when it's discontinued. Assessments can be made...should be made...of the pt's state of recovery for a while *after* the vivitrol has been removed.


My Response-The fact is we don’t really know what effect naltrexone has on long term sobriety, and that is the most honest answer a physician can give. How physicians get paid really is irrelevant to me.
A: Agree. However, IMO pts shouldn't be cut loose from care at the same time vivitrol is removed. To me we are just setting them up for failure...or worse. An appropriate approach would be to bring them off vivitrol and continue CBT or your therapy of choice for at least another 8 weeks.


My Response-This is the only true dishonesty I seen in your responses. 5-12%? Where are you getting your figures and how were these studies set up? What population are we talking about, any who walks into an AA meeting? Or are we talking about someone who completed 5-6 weeks treatment, and a year at a half way house? Also, if the inadequacy was within the programs themselves, then why do airline pilots and physicians have 90+% 5 year sobriety rates? It’s not a program problem. It’s an accountability problem. Give me some legal leverage on a patient to help with motivation and we can produce 5 year numbers that would exceed most people’s expectations.
A: Interesting...you challenge my numbers and then offer an undocumented one to support your claim : - )
We do not disagree on accountability, which is why I would also agree on a higher success rate for professionals who have routinely embraced responsibility in other aspects of their lives. But these pts are the Lance Armstrong's of addiction. They are programmed for success and their use is an anomaly in their life - and probably in the global stats of recovery. The vast majority of heroin addicts don't have that foundation of professional success and history of personal responsibility to tap into. As far as legal leverage, every action an opiate addict takes to further their use is illegal. My guess is that in your area well over a third of pts present *because* of legal issues. You might not see them, but the drug courts do. We can't get much more legal leverage on them than that. And if you were referring to the ability to derail their career, what career can you derail from most addicts? Buying drugs? Selling drugs? Prostitution? Their 'careers' are already dead...the battle now is for their bodies.

I believe many addicts live long and sober lives having never been involved in any MAT. I don't know what that 5-year sobriety number is, but I doubt anybody is satisfied with it. I also believe many addicts live long and sober having gone through an MAT program. I don't know what that 5-year sobriety number is either, and I doubt anybody is satisfied with it.

I also know that I have a personal responsibility to ensure pts have every opportunity to recover and live a sober life, and vivitrol can play a role in that process.

 

[Anonymous]

Here is some support for the numbers I mentioned. I don't know where the original studies came from but I have heard these types of numbers for years. It's also clear that these treatments are fairly standardized so what you see is what you get. It's an easy population to study and get accurate sobriety numbers on.

http://findarticles.com/p/articles/mi_m0QTQ/is_5_4/ai_n24994713/

As for your last paragraph, when you mention the "Lance Armstrongs of recovery", that made me chuckle a bit. While I acknowledge the truth in talking about success in other walks of life, you also deal with egos and grandiosity. I find many of these successful, intelligent addicts have a hard time finding the humility and brokeness (which leads to them being teachable) that may come more easily to those who are not the "Lance Armstrongs". And IMO, humility is a huge part of this process. I truly believe you could place physicians up against joe blow addict in the same situation with no monitoring and the numbers would be similar. Obviously, that is just a belief of mine but I see intelligence and success as actual hinderances to connecting to the program of AA, NA. It's one more thing I have to battle with this group...needing to understand how it works, connection to the program, will power being the driving force for recovery, being too smart for it all etc.

 

[Anonymous]

I don't mean to be the arbitor of this disagreement but I would have to say Pro Vivitrol Physician vs Anti Vivitrol physician has a winner and it ain't the anti Vivitrol physician.

I am glad that there are some responsible physicians out there that understand that addicts need every opportunity to get themselves clean and sober.

 

[Anonymous]

I don't mean to be the arbitor of this disagreement but I would have to say Pro Vivitrol Physician vs Anti Vivitrol physician has a winner and it ain't the anti Vivitrol physician.

I am glad that there are some responsible physicians out there that understand that addicts need every opportunity to get themselves clean and sober.

I have been involved in the task force in southern Ohio to address the opiate crisis. There was one primary care physician who was the 10th highest distributor of OxyContin in the US...and this is an entire county of 70,000, with 9 other cash-only pain clinics, also prescribing or distributing OxyContin. This ranking came from a DEA investigator in Florida.

Alkermes just started a pilot program here in Ohio for Vivitrol, and 2 of the sites are in southern Ohio. We've had several hundred deaths caused by OxyContin overdose, and the numbers don't include people who were transported out of county and died at another hospital, or those who died in accidents or as a result of OxyContin related violence.

I know several addicts who have started taking Vivitrol after detoxing with Buprenorphin and are doing well. Most are back to work and look like they did before the addiction started. I think this may be the best drug that's ever been used in addiction medicine.

 

[Anonymous]

I don't mean to be the arbitor of this disagreement but I would have to say Pro Vivitrol Physician vs Anti Vivitrol physician has a winner and it ain't the anti Vivitrol physician.

I am glad that there are some responsible physicians out there that understand that addicts need every opportunity to get themselves clean and sober.

And usually those people with this mentality also believe that "every opportunity" consists of medicating depression, anxiety and insomnia. So forgive me if I take your opinion with a grain of salt. I would place our treatment facilities 5 year sobriety numbers against any other facility in the country. And we do this by giving our patients every opportunity to be chemical free. This is the true definition of sobriety.

 

[Anonymous]

And usually those people with this mentality also believe that "every opportunity" consists of medicating depression, anxiety and insomnia. So forgive me if I take your opinion with a grain of salt. I would place our treatment facilities 5 year sobriety numbers against any other facility in the country. And we do this by giving our patients every opportunity to be chemical free. This is the true definition of sobriety.

The problem is that not everybody has access to treatment, or is ready for treatment. I use to be just as self righteous about the definition of recovery and the value of medications as you are. But when we got over a hundred pictures of dead young people from OxyContin hanging in a window on Main Street, I got humbled. Especially when we hung my young nephew's picture up there. He died before he ever realized he was addicted. I had people dying on our waiting list, before they ever had the chance to come in. There are lots of different definitions for "recovery." You are entitled to your opinion, but so is everybody else.

 

[Anonymous]

The problem is that not everybody has access to treatment, or is ready for treatment. I use to be just as self righteous about the definition of recovery and the value of medications as you are. But when we got over a hundred pictures of dead young people from OxyContin hanging in a window on Main Street, I got humbled. Especially when we hung my young nephew's picture up there. He died before he ever realized he was addicted. I had people dying on our waiting list, before they ever had the chance to come in. There are lots of different definitions for "recovery." You are entitled to your opinion, but so is everybody else.

So, I am self righteous and I need some humility? You do not know me or my heart for addicts. I am in recovery myself, and consider addicts and alcoholics "my people". But, none of that means anything...and your emotional plea doesn't change the facts either. (and my heart goes out to any family who has lost a loved one to this illness). People who use mind altering substances to treat symptoms ie insomnia, depression, and anxiety will likely relapse or become addicted to new substances. How does that help all these oxycotin addicts you would like to medicate? I can also show you plenty of opiate addicts who overdosed because they decided to push on those receptors while taking Vivitrol.

There is no long term evidence that Vivitrol works. It's all heresay, and conjecture. It's case studies, and opinion. Me personally, I believe we need to be VERY careful before the medical community promotes any chemical for recovery. Look at methadone and suboxone. We have created a monstor in the name of "recovery". So, you will have to forgive me if I am protective of addicts and alcoholic. I am protective of recovery and what that looks like. I am one of the few voices who still promote these things within the medical community and I find that very unfortunate.

 

[Anonymous]

So, I am self righteous and I need some humility? You do not know me or my heart for addicts. I am in recovery myself, and consider addicts and alcoholics "my people". But, none of that means anything...and your emotional plea doesn't change the facts either. (and my heart goes out to any family who has lost a loved one to this illness). People who use mind altering substances to treat symptoms ie insomnia, depression, and anxiety will likely relapse or become addicted to new substances. How does that help all these oxycotin addicts you would like to medicate? I can also show you plenty of opiate addicts who overdosed because they decided to push on those receptors while taking Vivitrol.

There is no long term evidence that Vivitrol works. It's all heresay, and conjecture. It's case studies, and opinion. Me personally, I believe we need to be VERY careful before the medical community promotes any chemical for recovery. Look at methadone and suboxone. We have created a monstor in the name of "recovery". So, you will have to forgive me if I am protective of addicts and alcoholic. I am protective of recovery and what that looks like. I am one of the few voices who still promote these things within the medical community and I find that very unfortunate.

Well, I, too have been in recovery 19 years. From opiates and alcohol. I did not use Vivitrol, nor any other drug to get or stay clean. I use to think that everybody should do it the way I did...that if I can do it this way and you can't, then you must not want it enough! Anybody that thinks that they should be dictating the pathway to recovery for someone else is self-righteous. We here in Southern Ohio learned the hard way. And, by the way, I've worked in that field for a minute or two as well, and I can tell you that as of yet, there is NO medication or method that has produced long term positive results for opiate addiction. NOTHING! Not NA, AA, Methadone, Suboxone or Vivitrol. Thank goodness science is still trying to find something! My friends in recovery who are taking Naloxone in any form are pretty happy with it. Sure, they can test it, but they don't. They like having the comfort of knowing it wouldn't do them any good, anyway.

 

[Anonymous]

Well, I, too have been in recovery 19 years. From opiates and alcohol. I did not use Vivitrol, nor any other drug to get or stay clean. I use to think that everybody should do it the way I did...that if I can do it this way and you can't, then you must not want it enough! Anybody that thinks that they should be dictating the pathway to recovery for someone else is self-righteous. We here in Southern Ohio learned the hard way. And, by the way, I've worked in that field for a minute or two as well, and I can tell you that as of yet, there is NO medication or method that has produced long term positive results for opiate addiction. NOTHING! Not NA, AA, Methadone, Suboxone or Vivitrol. Thank goodness science is still trying to find something! My friends in recovery who are taking Naloxone in any form are pretty happy with it. Sure, they can test it, but they don't. They like having the comfort of knowing it wouldn't do them any good, anyway.

Doing my training in Eastern Ky, I know the problem in that region. It is an epidemic. I in no way believe another addict or alcoholics recovery needs to look like mine. But, as a physician who's reasoning is based in science and the art of observing large populations of addicts, I realize there is nothing to support the use of Vivitrol. Second, I would disagree with you. 12 step programs have produced a community around our treatment center that has very good success rates with opiate addicts. I know many who have long term sobriety. I'm not against the use of medications. I am against the use of them without any real evidence of their efficacy. I am against addicts going to docs who believe in medicating symptoms of addiction. If Vivitrol shows me some 5 year numbers that are solid, non manipulated and substantial...I will be on board. Until then I will protect what I know works, with proper motivation and accountability.

 

[Anonymous]

PS-It is my job to dictate pathways to recovery for patients. That is what I get paid to do. Should I allow the patient to dictate that for themselves?

 

[Anonymous]

Doing my training in Eastern Ky, I know the problem in that region. It is an epidemic. I in no way believe another addict or alcoholics recovery needs to look like mine. But, as a physician who's reasoning is based in science and the art of observing large populations of addicts, I realize there is nothing to support the use of Vivitrol. Second, I would disagree with you. 12 step programs have produced a community around our treatment center that has very good success rates with opiate addicts. I know many who have long term sobriety. I'm not against the use of medications. I am against the use of them without any real evidence of their efficacy. I am against addicts going to docs who believe in medicating symptoms of addiction. If Vivitrol shows me some 5 year numbers that are solid, non manipulated and substantial...I will be on board. Until then I will protect what I know works, with proper motivation and accountability.

I am pretty sure Vivitrol isn't going to be able to show you any numbers that you believe aren't manipulated or are subtantial. Why don't you just say it. Your scientific reasoning is being overtaken by your personal biases and prejudices. 12 step programs have horrible, horrible relapse rates and success rates in general, however you base success.

 

[Anonymous]

Who cares? Cephalon and Vivitrol are long gone. Go find someone who gives a sh:t!

 

[Anonymous]

Vivitrol is an excellent drug, works for both alcohol as well as opiate addiction. The issue with Vivitrol when Cephalon was marketing it for Alkermes was that Cephalon did not put any effort behind sales and did not coordination with thinking about life cycle management with Alkermes. Alkermes got fed up. But it is a great drug and should be combined with support groups or similar therapy to have the greatest long term success.

 

[first time]

I started drinking alcohol when I was 15 years old and am now 33. For the last 4 years I have been trying to quite, I have tried lots of diffrent things; AA meetings,church,gym,counslers,books. I have recieved alot of benfits from these things and even managed to put 3 months of sobriety together about two years ago. The one thing I have never been able to shake is the cravings for alcohol. So I got my first shot of vivitrol on thursday morning. Then friday night a friend asked if I wanted a beer I said no maybe later so we went and sat on the step to talk. Thats when the wierdest thing happened my freind was talking to me and I could smell the beer on his breath is smelled of old stale rotten beer. For what ever reason it grossed me out and I still havent drank. Its only been two days so I am not sure if its the vivitrol or not what I am sure of is that this is was the first friday I have been sober in a long time as of right now I have no desire to drink. I truly hope vivitrol works.

 

[Anonymous]

I started drinking alcohol when I was 15 years old and am now 33. For the last 4 years I have been trying to quite, I have tried lots of diffrent things; AA meetings,church,gym,counslers,books. I have recieved alot of benfits from these things and even managed to put 3 months of sobriety together about two years ago. The one thing I have never been able to shake is the cravings for alcohol. So I got my first shot of vivitrol on thursday morning. Then friday night a friend asked if I wanted a beer I said no maybe later so we went and sat on the step to talk. Thats when the wierdest thing happened my freind was talking to me and I could smell the beer on his breath is smelled of old stale rotten beer. For what ever reason it grossed me out and I still havent drank. Its only been two days so I am not sure if its the vivitrol or not what I am sure of is that this is was the first friday I have been sober in a long time as of right now I have no desire to drink. I truly hope vivitrol works.

Go away you drunken loser!

 

[Anonymous]

Thats druken electronics engineer to you.

 

[Anonymous]

I am pretty sure Vivitrol isn't going to be able to show you any numbers that you believe aren't manipulated or are subtantial. Why don't you just say it. Your scientific reasoning is being overtaken by your personal biases and prejudices. 12 step programs have horrible, horrible relapse rates and success rates in general, however you base success.

You are saying that I care more about my personal biases then I do about addicts. Not only do you not know me, but you judge me without knowing me. Is that part of your recovery program? Maybe there is a medication that can help with that.

I can tell you that I would be very much on board with a medication I know works to promote long term sobriety. But, up to this point there isn't one...certainly not one with any long term numbers.

Let me ask you a question. If you rolled up into an oncologists clinic and showed him/her a 12 week study on a new cancer drug, with 12 week safety/and efficacy numbers...what do you think his/her response would be?

You would be laughed out of the clinic. A good oncologist would be protective of his patients, and treatments he knows work. You had better show him long term numbers with studies that are solid, and well built. Why would addiction be any different?

 

[Anonymous]

You are saying that I care more about my personal biases then I do about addicts. Not only do you not know me, but you judge me without knowing me. Is that part of your recovery program? Maybe there is a medication that can help with that.

I can tell you that I would be very much on board with a medication I know works to promote long term sobriety. But, up to this point there isn't one...certainly not one with any long term numbers.

Let me ask you a question. If you rolled up into an oncologists clinic and showed him/her a 12 week study on a new cancer drug, with 12 week safety/and efficacy numbers...what do you think his/her response would be?

You would be laughed out of the clinic. A good oncologist would be protective of his patients, and treatments he knows work. You had better show him long term numbers with studies that are solid, and well built. Why would addiction be any different?

And Boo yah...there it is. Case closed.

 

[Anonymous]

I'm a rep from another company and have been an alcoholic for 10+ years. I am at a point where I absolutely must do something but can't imagine going into an inpatient treatment center. I saw a post on another page about Vivitrol and saw the physician locator. I tried Campral a couple of years ago, but I never made it through the 5-day drying out period and basically just lied to the prescribing doctor so he would give it to me...but of course it was not effective without that wash-out period. So is Vivitrol better? Does it really work? I don't want to go to another doctor, spill my guts and try this if it isn't really effective. Please, serious replies only-please.

Yes. It works. I too am an alcoholic, and have been for many years. I've tried all kinds of things, even hypno-therapy, Campral, Antabuse, none of it worked. The Vivatrol has removed my cravings. I went into a 3 day in patient to de-tox, then was on the pills for 10 days. I still had cravings on the pills. I received the shot last Friday, and have been craving-free. There were several events that would have triggered a binge, but the Vivatrol kept it at bay. Currently, I'm on a business trip and would be drinking on my expense account. Instead, I'm enjoying myself and am not obsessing about how I am going to get my next drink! Freedom from alcohol is amazing. I still may be in the pink cloud, but it feels pretty darn good!