Vivitrol Use in Drug Addiction Treatment
What Is Vivitrol?
Vivitrol is a medication used in the treatment of alcohol and opioid addiction and dependence.1 It works to block the euphoria associated with opioid use and alcohol intoxication.3 Its major benefit is that it need only be administered once per month.
As advances in medication are paired with an increased understanding of substance abuse, physical dependence, and addiction, new treatment options emerge to aid those struggling with these issues. One recent development is the approval of a medication used in alcohol dependence and opioid addiction treatment, called Vivitrol.
Naltrexone vs. Vivitrol: What’s the Difference?
Vivitrol is naltrexone—it is just one form of it. Vivitrol is one of the brand names for naltrexone, and it is unique because of its route of administration and duration of action. Rather than being taken orally, it is an extended-release injection, often referred to as ‘the Vivitrol shot’.1,2,3 This shot is an intramuscular injection that is given into alternating buttocks each month by a health care professional.1,2
The main benefit of the drug is that it only needs to be administered once every 4 weeks, which helps to increase compliance with treatment and, as a result, substance abstinence.1,2,3 Other forms of naltrexone are taken orally in pill form every 1-3 days.3,5
Vivitrol is an effective part of medication-assisted treatment (MAT), which is a method of addressing addiction that combines therapy with medication. Vivitrol helps to both reduce cravings and lower the risk of relapse.3,4
Who Should Use It?
Vivitrol has many advantages as a treatment for alcohol and opioid addiction. It may be a good option if:5
- You take your treatment and recovery seriously.
- You have stopped using alcohol and/or opioids (Note: You must have been off opioids for a minimum of 7-10 days).
- You are in the early stages of opioid recovery.
- You have had poor success with other medications or other forms of addiction treatment.
Who should NOT use It?
You should not use Vivitrol if you are:1,3,5
- Allergic to naltrexone.
- Using opioids to manage chronic pain.
- Abusing opioids or in early withdrawal. (An individual should abstain from opioids for at least 7-10 days before starting Vivitrol.3)
- Suffering from acute hepatitis or liver failure.
How Does It Work?
Vivitrol acts as an opioid antagonist by blocking the rewarding effects of alcohol and opioids.3
A drug like heroin, which is an opioid agonist, works by binding to and activating opioid receptors. When Vivitrol is used, it competitively binds at the same receptor sites, and in doing so, prevents other opioid drugs from activating them.1 This effectively prevents the euphoria, or “high”.3 With the pleasurable effects gone, the individual is less likely to want to consume the intoxicating substance. Without the reward, there is no motivation to maintain the behavior. It is important to note that addiction and physical dependence are multidimensional problems.
Vivitrol is not a cure for addiction, and it is most effective when used in a complete treatment program with therapy and social support.3
As an opioid antagonist, Vivitrol is very different from other prescriptions used in MAT, such as methadone and buprenorphine, which provide some of the effects of opioids but in a controlled manner that prevents intoxication and impairment.6 While drugs like methadone can be very effective, they can be misused to get a more intense high and, as with other opioid agonist drugs, there is a risk of addiction. Users can become physically dependent on these drugs and may experience withdrawal when going off them.
With Vivitrol, there is no euphoria and thus no potential for abuse or addiction. And it does not produce physical dependence, so there is no associated withdrawal syndrome.7
Finally, because it is administered only once every 4 weeks, it provides a full month of treatment without the user having to make the conscious decision to continue taking it, making it easier to stay sober.
Side Effects and Risks
Of course, even the safest medications have risks and the potential for unwanted side effects. When used as prescribed, Vivitrol side effects may include:1,2,3,5
- Lowered appetite.
- Dry mouth.
- Fatigue and problems with sleeping.
- Pain and stiffness in joints.
- Muscle cramps.
- Feeling weak or dizzy.
The Vivitrol shot can lead to issues at the injection site like:1,2
- Wounds and scabs.
In some cases, Vivitrol may cause:1,3
- Liver damage/hepatitis (if excess naltrexone is taken).*
- Severe pneumonia caused by an allergic reaction.
- Precipitated withdrawal. If someone has recently used opioids (less than 7-10 days before injecting Vivitrol), the substance can bring about uncomfortable withdrawal symptoms.1,3
The final risk of Vivitrol is an increased risk of overdose if the user relapses. Individuals that have used the drug will be more sensitive to opioids and more susceptible to overdose if they return to drug use after stopping Vivitrol.3
*Liver damage/injury may also occur in patients with an existing liver disease.
Where Can I Get It?
Another factor that separates Vivitrol from other medications used in MAT is its wider accessibility. Vivitrol is available from any medical professional that can prescribe medications. They do not need special qualifications required for certain drugs like buprenorphine.3
While effective, methadone and buprenorphine have more restrictions and may be more difficult to access.7,8 Methadone is administered only at specialized opioid treatment programs (OTP). Buprenorphine is easier to obtain than methadone, but physicians who wish to prescribe it must receive a waiver from the Substance Abuse and Mental Health Services Administration (SAMHSA).8 The waiver puts limits on the number of patients the provider can treat.3 There is no such restriction on naltrexone prescribing, meaning you may be able to get it from your physician.
Many inpatient/residential addiction treatment programs also offer MAT, so if you’re interested in Vivitrol as part of a comprehensive substance abuse treatment program, you can search for providers that offer this method of treatment. Remember, the drug should be used in combination with therapy, and this combination of medicine and therapeutic support may be found at numerous addiction treatment programs around the country.
What Does It Cost?
Vivitrol is a newer medication used to treatment substance dependence. There are currently no generic forms of the monthly naltrexone shot, so the cost of Vivitrol cost can be quite high. Someone paying full price for the drug without insurance or discounts can expect a cost of $1,000 per month or more.9 The amount is significantly higher than the cost of methadone maintenance treatment.10
To address this issue, the makers of Vivitrol offer a copay reduction program to reduce the costs related to the drug. If you go to the website and verifying your eligibility, the program can pay up to $500 towards your copay or deductible for the monthly prescription.11 There’s good news for insurance-holders, too: more than 90% of people with insurance coverage that use the copay reduction program have zero out-of-pocket costs associated with their Vivitrol prescription.11
The Controversy Over Medication Use in Sobriety
People that use forms of MAT to maintain their recovery might face some resistance from certain support groups and other programs that promote an “abstinence-only policy.” To these groups, which include Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), using MAT does not equate to true abstinence.7
Someone interested in incorporating support groups into their recovery program should check to see if that organization or local meeting acknowledges the benefits of Vivitrol during recovery, or if its use violates the “abstinence-only policy.”
Everyone’s recovery experience is a highly personalized journey towards a drug-free lifestyle and a happier life, and it doesn’t have to fit into a rigid definition of sobriety that another person or group uses. One person’s path to recovery will look very different from their peers’. It is important for every individual to work with a treatment team to find what options work best for them. Many will find success with the combination of behavioral therapy, support group meetings, and Vivitrol.
1. U.S. Food and Drug Administration. (2010). Vivitrol.
2. U.S. National Library of Medicine: MedlinePlus. (2010). Naltrexone Injection.
3. Substance Abuse and Mental Health Services Administration. (2016). Naltrexone.
4. National Institute on Drug Abuse. (2010). Important Treatment Advances for Addiction to Heroin and other Opiates.
5. Substance Abuse and Mental Health Services Administration. (2012). The Facts about Naltrexone.
6. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
7. Substance Abuse and Mental Health Services Administration. (2011). Medication-Assisted Treatment for Opioid Addiction.
8. Substance Abuse and Mental Health Services Administration. (2005). Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs.
9. CBS News. (2016). Monthly Vivitrol Treatment Helps Fight Heroin Addiction.
10. French, M. T., Popovici, I., & Tapsell, L. (2008). The Economic Costs of Substance Abuse Treatment: Updated Estimates and Cost Bands for Program Assessment and Reimbursement. Journal of Substance Abuse Treatment, 35(4), 462–469.
11. Vivitrol. (n.d.). Co-Pay Savings Program.