Vivitrol is a relatively new medication used to manage alcohol or opioid dependence. It’s a long-acting injection of the drug naltrexone, effective for about 28 days, which offers the convenience of a once-a-month injection over taking a pill every day. Vivitrol is a “hard stop” to opiate addiction; once it’s in the body, it’s impossible for the person taking it to get “high” from opioids. Using Vivitrol will also reduce the person’s cravings for opioids.
Vivitrol is similar to Suboxone in that both are prescribed to treat opioid dependence. Suboxone contains both buprenorphine, a mild opioid medication known as a partial agonist, as it only partially stimulates opioid receptors in the brain, and naloxone, which is an opioid blocker. (Naloxone and naltrexone, though similar, are different drugs.) It’s much easier to make the transition from active use to a Suboxone prescription; most patients can transition 24 hours after their last opioid use – certainly within the period of withdrawal, but within a timeframe that many people can manage through willpower alone. Vivitrol, on the other hand, requires that the patient have 10-14 days completely free from opioids before the drug can be administered. This is a high barrier for someone currently struggling with substance use: most people actively using cannot go two weeks without it, as the experience of withdrawal—the intense, uncomfortable flu-like symptoms, agitation, and anxiety—is simply too powerful. A doctor can prescribe “comfort medications” to help a patient persevere through this two-week period, but most people start Vivitrol after completing inpatient treatment, or after being prescribed and then tapering down from Suboxone.
The use of medications like Vivitrol and Suboxone is known as Medication Assisted Treatment (MAT) or Medication Assisted Recovery (MAR). People engaging in Medication Assisted Recovery are prescribed medications to assist them with maintaining recovery—and many people find these medications to be incredibly helpful. Although Vivitrol and Suboxone, in particular, can be extremely useful in assisting people to engage with and maintain recovery, they’re not cure-alls: alcohol and opioid dependence involve a number of lifestyle factors, and these must be addressed, as well, to build long-term recovery.
Other Factors to Consider
Many factors go into active addiction, and so many factors must be considered to achieve recovery. (That’s why treatment can take months—and sometimes even years!) Successful treatment must consider the patient’s living situation, work (or lack of work), friendships, sexual and romantic relationships, and financial situation. To evaluate if Medication Assisted Recovery is the best choice for an individual patient, it’s wise to look at the whole picture of their addiction.
When someone uses alcohol or opioids excessively, they eventually become accustomed to the action of the drugs and develop a tolerance to them. Over time, the drugs are used simply to maintain normalcy for the individual. This process, transitioning from casual use to dependence, usually involves powerful cravings and a tremendous loss of control—which is particularly dangerous, as the higher tolerance that comes with dependence is often what leads to overdose. For many people who heavily use drugs, managing—and avoiding!—withdrawal becomes a primary motivator in life. I’ve seen people, now in recovery, who at one time thought about how to get drugs from the moment they woke up, and who spent all day, every day, planning about how to maintain their “high.”
Medication Assisted Recovery addresses one factor: the drug itself. Knocking out physical dependence on the drug can create psychic space to address the other factors—money, career problems, relationships—and the time to do necessary emotional work. Once someone is on Vivitrol or Suboxone, they no longer need to obsess about obtaining their drug of choice, and they no longer need to spend time or money on pursuing drugs. Many people find this new free time to be somewhat disorienting. But it can also be filled with the work of recovery—attending meetings, going to therapy, building a sober network. I always recommend that the person in recovery and their family work to build new support systems. One way of going about this process is through attending group therapy or mutual aid groups, also known as Twelve Step groups, which are available to families as well as individuals struggling with substance use. For the person in recovery, making new friends that understand and share their experiences can be crucial for long-term sobriety, and families can benefit from hearing from others who share their experiences as well. Addiction involves the whole family, and recovery can too.
Vivitrol or Suboxone are not the end of the journey: really, they’re just the beginning. A strong support system and attendance at therapy or mutual aid groups are also crucial pieces of the puzzle.
With other supports in place, Vivitrol can be an important piece of the recovery process. The correct use of Vivitrol depends on a number of factors, which your prescribing doctor will take into account; the biggest barrier to treatment, for many people, may be the 10-14 days entirely free from opiates that must precede the first dose. It’s crucial, too, to have Vivitrol administered at the scheduled times—every 28 days—and to stay up-to-date with the dosage. It’s certainly not a one-time drug, nor will it “cure” anyone’s use of opiates. Like a lot of medications, it’s something that should be taken on a consistent basis.
With this in mind, it’s important to note that taking Vivitrol may leave some people particularly vulnerable to overdose at the end of the 28-day cycle. Vivitrol lowers a person’s tolerance to heroin and other opioids, meaning that there is a higher rise of overdose after a missed dosage or at the end of the treatment period. It’s important to be safe—so, if someone is taking Vivitrol, they should both be aware of the potential for overdose and try to abstain from using all other drugs, if possible. Understanding that overdose may happen at a lower dose than when treatment began is very important. If someone returns to using heroin or other opiates after being prescribed Vivitrol, they are at a much higher risk of overdose than they were before.
Family members of people using opiates should have an understanding of overdose and, if they haven’t already, get training on the medication used to counteract overdose—Narcan, or naloxone. Most drug treatment centers and public health facilities offer training on how to administer Narcan during an overdose, and some states have made access to Narcan free at local pharmacies. While naloxone is also an ingredient in Suboxone, in this case it is used as an instant opiate blocker, and it can be an essential tool in bringing someone back from an overdose.
Getting a Prescription
If someone has decided that Vivitrol is the right choice for them, they will go through an extensive process with a doctor to ensure that they can be safely prescribed the medication. Before someone receives their first dose of Vivitrol, the prescribing doctor will ask detailed questions about their recent substance use, their health, and any other physical or mental health challenges. Then comes a drug test—usually urine, but it may also be a saliva-based test. They will also be given a physical exam and tested for diseases common in people who use substances heavily. If, after all this testing, it still appears that Vivitrol is the best and most appropriate choice, the prescribing doctor will take next steps to prepare their patient for the first dose.
Many people in recovery from alcohol or opiates choose to make Vivitrol or Suboxone part of their journey. At Suntra Modern Recovery, we offer programs to transition from drug use to a Suboxone prescription, or from drug use to a Vivitrol prescription. Suntra simplifies the process of getting these prescriptions by offering physician visits over video chat as well as at-home detoxification services (“at home detox”) for any residents of New York State.
Vivitrol For Alcohol Addiction
Beyond treating opioid addiction, Vivitrol is also used in the treatment of alcohol use disorder. Naltrexone, the ingredient in Vivitrol, also reduces cravings for alcohol, and people who take it regularly often drink less—while some are able to completely abstain from alcohol. When people take naltrexone orally, they often don’t take it on days they might want to drink and sometimes stop taking it altogether. Taking Vivitrol ensures that the medication will stay in the body for 28 days and does not depend on day-to-day compliance.
Some people who choose naltrexone for alcohol use intend to learn how to drink more safely. This is sometimes known as the Sinclair Method; some people refer to it as “harm reduction,” “soberish,” or “alt-sober.” The Sinclair Method has been shown to decrease the craving for alcohol and is directly correlated with a decrease in the frequency of an individual’s drinking, sometimes to the extent of total abstinence. Some people use Vivitrol on the Sinclair Method; in this strategy, the idea is that the Vivitrol will block the serotonin response from alcohol use, which will make the person see that drinking no longer fulfills their cravings.
The Sinclair Method – using naltrexone or Vivitrol, plus therapy – has shown great success with people who want to learn to control their drinking. By slowly reducing cravings, some people stop drinking altogether. Several months using Vivitrol or naltrexone to curb cravings can begin to retrain the brain and bring someone into long-term recovery.
The Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline, also known as the treatment referral routing service, can be an important resource for people struggling with substance use. The helpline is available 24/7, 365 days a year, and is a free and confidential service that provides callers with any information they need about rehabilitation centers and support groups. The helpline can also connect callers with providers who can prescribe medication used for dependence on opiates or other drugs.
Suntra Modern Recovery can also provide access to recovery medications like Vivitrol, naltrexone, and Suboxone. The first step to recovery with Suntra is to get in contact with us—simply send us a text, and we’ll connect you with a recovery coach who will gather background information on your situation and develop a plan for recovery with you. At Suntra, the first doctor’s visit can be done that very same day over a video call.
We have a great deal of experience helping patients detox from opiates, alcohol, and other drugs. Patients living in New York can choose to detox at home, while others choose to come in to our office. Your detox protocol will depend on the kind and quantity of drugs you have used recently.
For some patients who were using heroin or other opiates, the right move is to make a transition to Suboxone. If this is the case for you, you should be able to transition within a matter of days. People who have taken Suboxone before, either through a prescription or off the street, will know what to expect and may have a fairly easy time making the shift. An at home detox to Suboxone, done in two visits, is more likely than a transition to Vivitrol—which can come later, and may be the next step for a patient after Suboxone. Vivitrol is one of the best drugs on the market for treating cravings for opioids and alcohol. While the medication alone does not treat addiction—only lessening the compulsion to use drugs and, in the case of opioids, acting as a blocker—it can be an important step to ensure someone is abstinent and engaged in the process of recovery. As always, support from family, friends, and a network of other people in recovery is essential. Committing to recovery isn’t something that people struggling with substance use, particularly those struggling with opioid use, can do all by themselves—but with the right help, recovery is possible. For many people, Vivitrol can be a first step.
Adam Banks is a certified recovery coach and interventionist at Suntra Modern Recovery. He received an MBA from the University of Chicago and built a company which United Health Care acquired. He learned his rigor and attention to detail from his career as an airline pilot, holding an ATP, the FAA’s highest license.
Suntra Modern Recovery provides medical treatment for alcohol and opiate addictions via video visit with medical doctors. Suntra’s alcohol and drug intervention services are available in New York, Long Island, and the Hamptons. Treatment for opiate and heroin addiction, including Suboxone treatment, can start today.