Vivitrol and Narcotic Addiction
Denali Healthcare and Dr. Robert Townsend have been actively treating narcotic addiction for years using Suboxone for weaning therapy. We are changing our practice model to use Vivitrol (a non-controlled substance that blocks the use of narcotics for 30 days at a time). The reason for this is twofold. The first is obviously that narcotic addiction is a major problem facing Michigan Residents. There is a tremendous need for quality addiction treatment. The second factor is that given the problem, law enforcement and the state are taking a very hard stance on the use of narcotics. Physicians and Clinics are under tremendous pressure by the authorities to stop narcotic use of any kind. A non-narcotic option is really the only recourse that physicians and patients have to deal with their addictions.
Summary of the Denali Healthcare Vivitrol Program
Candidates for the Denali Vivitrol Program will come in for an initial evaluation to include a History and Physical. We will explore their history of Narcotic Addiction, triggers, methods of use, amount and frequency. Any legal issues will also be addressed. Patients will NOT receive Vivitrol on the first visit- a prescription will be issued and we have local pharmacies that will obtain the medication for the patient. Patients will also be tested for liver function at a local lab. Screening for Hepatitis C will be ordered if the patient is at risk.
At the next visit one to two weeks later, the patient will bring the Vivitrol with them for initiation of therapy. Patients MUST be opiate free at that visit, to confirm this a urine drug screen will be obtained. We will also administer 2mg of Narcan in the office to test for opiate withdrawal. If the patient tolerates the test dose, the Vivitrol will be administered. Patients will come into the office at 4 week intervals for additional injections of Vivitrol for the duration of therapy.
Cost for the initial two visits will be $350 in total and each follow up visit is $100. Patients are responsible to obtain their Vivitrol under the terms of their insurance from the pharmacy. We will provide the initial Narcan Challenge and Urine Drug Screen. Patients will be responsible to pay for follow up urine drug screens as needed at a cost of $50. Commonly patients have 2-3 random urine tests a year, but you can be tested at ANY visit.
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A Narcotic Free Option
As the science of addiction medicine evolves, doctors have used new drugs in revolutionary ways that are changing how we think of and treat addiction. Vivitrol is a drug used to treat both opioid addiction as well as alcoholism. Since approved it has been used successfully by many programs to treat addiction to both prescription and illegal narcotics. It is an excellent alternative for those that cannot use opiate based addiction therapy due to employment or legal requirements.
What Is Vivitrol?
Vivitrol is an opiate antagonist. To help understand what this means, the body has ‘receptors’ which function like ‘locks’. Each ‘lock’ takes a particular ‘key’, and the opiates fit into the opiate receptors like a ‘key’ and turn the ‘lock’ for an effect. Vivitrol is a ‘key’ that looks like an opiate, but once it is inserted in the lock it does not turn the lock and it blocks other opiate ‘keys’ from going into the ‘lock’. That is why it is called a ‘narcotic blocker’.
How Is Vivitrol Different From Oral Naltrexone?
Unlike oral naltrexone (which must be taken every day without fail), Vivitrol is a monthly injection given in the doctor’s office. This has two advantages: 1) medical professionals can monitor a patient’s compliance and remind the patient when the next dose is needed. 2) With a monthly injection there is no room to ‘cheat’ or skip a dose if tempted to relapse. Many patients report that they have a greater peace of mind because the opportunity to relapse is out of their hands. Using narcotics while Vivitrol is active in the body has no effect as they cannot bind to narcotic receptors.
Pros of Vivitrol Use:
There are many benefits to using Vivitrol under the care of a physician. Vivitrol appeals to many doctors and patients alike, who do not wish to treat an opioid addiction with another opioid medication (also known as agonist therapy). Daily oral medications can be difficult to remember and may conflict with travel schedules or work/family needs- This problem is solved with a once monthly injection. Many patients suffering from narcotic addiction may also be involved in the court system, and a once a month injection as a condition of probation is a good alternative to incarceration.
For some, using Vivitrol while actively engaged in counseling and self-help groups (such as AA, NA or SMART Recovery) results in lasting sobriety, even after Vivitrol is discontinued.
Vivitrol is an ideal choice for patients coming off of methadone or buprenorphine (maintenance drugs) especially in the first few months, when they are at greater risk for relapse.
Cons of Vivitrol Use:
Perhaps the biggest con to Vivitrol is its cost. Unless one has private insurance that covers prescription drugs, Vivitrol is very expensive. The shot can run up to $1200 per month (even higher in some cases). Many insurance companies help offset most or all of the cost of the medication, and the manufacture has programs to help those without insurance or those with high co-pays. Denali Healthcare will help with insurance prior authorizations if needed. Even though it is expensive, it is still cheaper than the alternative of continuing addiction (both financially and in quality of life).
The most challenging ‘Con’ of Vivitrol is that it blocks all narcotics, including those used for acute pain, such as a broken bone. While this can be managed with a variety of medications, the pain control for an acute injury is challenging if it occurs shortly after an injection of Vivitrol. But the potential of having an injury with diminished options for pain control should not interfere with the surety of a continued addiction. We do continue to drive automobiles despite the possibility of severe injury and pain if we have an accident.
Finally, as with all prescription drugs, there are side effects. It should be noted that with Vivitrol treatment, tolerance for narcotics will decrease over time. Stopping the Vivitrol program after several months CAN lead to narcotic overdose and death if the patient attempts to abuse narcotics at their pre-program levels.
Vivitrol has many advantages and several disadvantages. It is important for patients and healthcare professionals to understand the full picture when considering Vivitrol for substance abuse treatment. The decision whether or not to take a drug like Vivitrol is an individual, case by case decision. If the decision is made to use Vivitrol, it should be done in conjunction with formal treatment and/or individual or group counseling for the best results.
Vivitrol is not a narcotic. The Vivitrol program is expensive, does not have the possibility of obtaining a ‘narcotic effect’, and is only for people serious about their recovery without the use of narcotics.