The study was published in the journal Lancet on Tuesday. A comparison of effectiveness of the two opioid addiction medications, Buprenorphine, known by the brand name Suboxone, and naltrexone, known by the brand name Vivitrol was made.
The study followed 570 patients with opioid addiction at eight inpatient treatment centers across the country for 24 weeks. Half of the group was assigned to naltrexone and the other half to buprenorphine. Only six percent of patients were unable to start the treatment with buprenorphine, fully 28 percent assigned to naltrexone dropped out before starting the therapy.
The study found that, while equally effective and safe, users had a more difficult time starting with the Vivitrol treatment. The Vivitrol treatment is an injection of naltrexone that lasts 28 days and has gained popularity with those in the criminal justice system. One drawback to this treatment is that an addict must have been detoxed or not used opioids for several days.
Suboxone, on the other hand, can be started immediately. It is a combination of buprenorphine and naloxone that is taken by mouth daily. “If you’re currently opiate-dependent … (naltrexone) takes more work,” said Dr. Joshua Lee, the lead author of the study, who studies opioid addiction behavior and treatment at New York University.
Big difference in the two medications
The study showed the problems between the two treatment regimens. Keep in mind that while once initiated, both treatments were effective, even though relapses are usually in the neighborhood of 50 percent.
However, Buprenorphine (like another addiction medication, methadone) is a long-acting opioid that’s taken daily. It not only helps reduce cravings but prevents withdrawal symptoms.
Naltrexone, on the other hand, is not an opioid. It blocks opioid receptors from activating so that even if someone injects heroin, it will block them from feeling high. But not being an opioid, naltrexone won’t stop withdrawal symptoms.
Keith Humphreys, a drug policy expert at Stanford who was involved in the Lancet study, summarized the findings for Vox: “If you get on the medication, both are equally effective, but it’s harder to get on naltrexone because you need the detoxification first.”
There is a fear that because Alkermes, the company who manufactures Vivitrol, has focused on marketing its product to nonmedical professionals in the criminal justice system, people will look at the study and oversimplify the results. After all, the criminal justice system does favor using non-opioid treatments.
Dr. Camila Arnaudo, an addiction psychiatrist who teaches at the Indiana University School of Medicine in Indianapolis, said, “I’m a little bit concerned about headlines that I’ve already seen,” she said.
She points out the fact that over half of addicts fail on these treatments and it is not publicized as it should be. “I’m concerned that it’s going to lead to policies where patients are shunted into treatment with extended-release naltrexone, which is more acceptable to the criminal justice system.”
“You’re weeding out the less committed people,” she said, and this skews the results in favor of Vivitrol. “I think we can say that both are viable options for patients and they prevent opioid use,” she said. “I think what we cannot say, though, is that they’re equivalent based on this study.” Basically, when it comes to these two treatments, one-size-fits-all does not apply.
