Vivitrol (now for opioid addiction)

Heroin-Plagued County Looks To New Medication To Aid Addiction (NY)

Last month, Suffolk County officials announced a program to incorporate Vivitrol at all levels of the criminal justice system. Officials from the drug courts, the probation office, and the sheriff’s department are developing procedures to recommend Vivitrol to addicts, when appropriate, and have been meeting with pharmaceutical representatives from the drug’s manufacturer, Alkermes.

Opiate addiction has hit Suffolk County hard; nearly 700 people have died from painkillers and heroin between 2012 and 2014, many of them young adults and teenagers. Others often end up in handcuffs, in front of judges, and later, in jails and prisons. Meanwhile, Vivitrol programs have launched in at least 26 states and will soon be permitted in places — including Suffolk County’s jails — where other medical treatments for heroin addiction have long been banned…

Naltrexone (INN, BAN, USAN) is an opioid antagonist used primarily in the management of alcohol dependence and opioid dependence.[1] It is marketed in generic form as its hydrochloride salt, naltrexone hydrochloride, and marketed under the trade names Revia and Depade. In some countries including the United States, a once-monthly extended-release injectable formulation is marketed under the trade name Vivitrol. Also in the United States, Methylnaltrexone Bromide, a closely related drug, is marketed as Relistor, for the treatment of opioid induced constipation.

Naltrexone should not be confused with naloxone nor nalorphine, which are used in emergency cases of opioid overdose…

Naltrexone helps patients overcome opioid addiction by blocking the drugs’ euphoric effects. Unlike when used for alcohol dependence (discussed above), naltrexone has little effect on opioid cravings.[8] Naltrexone has in general been better studied for alcohol dependence than in treating opioid dependence. It is also more frequently used for alcohol, despite originally being approved by the FDA in 1984 for opioid addiction.[9]

A 2011 review of studies suggested that naltrexone was not significantly superior to placebo or to no pharmacological intervention, nor was naltrexone superior to benzodiazepine or buprenorphine. Because of the poor quality of the reviewed studies, the authors concluded that there was insufficient evidence to support naltrexone therapy for opioid dependence.[10] While some patients do well with the oral formulation, there is a drawback in that it must be taken daily, and a patient whose cravings become overwhelming can obtain opioid intoxication simply by skipping a dose before resuming opioid use. Due to this issue, the usefulness of oral naltrexone in opioid dependence is limited by the low retention in treatment. Oral naltrexone remains an ideal treatment only for a small part of the opioid-dependent population, usually the ones with an unusually stable social situation and motivation (e.g., opioid-dependent health care professionals).

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