On the 12th of October 2010, the FDA has approved another tool for the treatment of opioid dependence: injectable naltrexone. Here are several links about this important development: FDA Press Release, CNN First Story.Vivitrol is the brand name for the injectable naltrexone approved by the FDA for the treatment of opioid dependence.
We have been using this medication for over two years in the treatment of opioid (narcotic) dependence and feel like it is an excellent medication for the right person. Up until today, this use has been "off label" meaning that the FDA did not directly endorse its efficacy in opioid dependence (it was previously FDA approved only for alcohol dependence).
Like all medications, injectable naltrexone is not for everyone. We have extensive experience in using this medication in two groups of patients. They are:
1) Individuals that have been using potent opioids (such as heroin, oxycodone and hydrocodone for a brief to moderate period of time (usually less than 3 to 5 years) who are motivated for abstinence and have some type of support (families who can set loving limits, a work setting or other social controls). Our greatest experience has been with young adults, ages 18 to 30 who become opioid dependent. In this group, injectable naltrexone provides a safety net after detoxification that prevents relapse while behavioral therapies (psychotherapy and 12 step support groups) begin to take hold.
2) The other group are individuals in safety sensitive jobs, such as health care workers. We have had over 25 years of experience in treating this population, and I can say that in this group, injectable naltrexone is the single most important new development in our treatment. We are having excellent outcomes in returning opioid dependent health care practitioners to work when they have considerable access to the very drugs that have been their downfall. At the same time, public safety is ensured.
Addiction is a complex disease with brain biochemistry changes, changes in emotional responses, behaviors, family dynamics and spiritual issues. Importantly, addiction is a disease of intense and dysfunctional learning. When someone is placed on naltrexone (Vivitrol and other trade names), our clinical experience is that their brain receptors for opioid drugs appear to return to the pre-addicted state within months. However, the learning, craving and emotional and behavioral changes the brain makes to "learn to be addicted" take many years to unwind. Vivitrol helps with the opioid receptors, but an enormous amount of change needs to occur in other brain circuits to attain solid recovery without strife.