Vivitrol and Suboxone: Recovery and Medically Assisted Treatment
Currently there are two drugs on the market, one frequently used to help people through the early withdrawals of opiate-based addiction, and the other through the early stages of recovery; suboxone and vivitrol. There are numerous arguments, debates, and discussions on the efficacy of both drugs by mental health professionals and individuals in recovery. This article is written to further the discussion on the issues related to suboxone and vivitrol, and to help people who are feeling uneasy about having to use these drugs for a medically assisted detox.
What is it?
Suboxone is a mixture of naloxone and buprenorphine. The naloxone in suboxone is meant to block the effects of the opiate in suboxone which is buprenorphine. It is intended to treat narcotic opiate addiction.
Issues related to Suboxone
There are numerous issues related to the use of suboxone to treat opiate addiction from a clinical and recovery view point. The issues I’ll be addressing are largely from the stance of someone dealing with substance use disorder. One of the main issues many people have with suboxone is that it is an opiate and it seems illogical to take an opiate to stop using opiates. Another is related to the simple fact suboxone is a revised version of a drug that has been around for decades, and it seems like the drug company producing it simply to profit off opiate users. The major issue though it is a drug that people buy and sell (like many other prescription opiates/narcotics) for the sole purpose of getting high.
The first time I ever heard of suboxone, was when it was being referred to by its nickname as subs. I was in prison and suboxone was much easier for people to have smuggled in than heroin. The effects and high were different, but similar enough that people were perfectly willing to take it as a substitute for their drug of choice.
At first, I thought it was just a potent opiate, like fentanyl, which I’d only ever seen in the patch form. Before getting involved with a 12-step fellowship and becoming active in recovery, I used any drug that was available. So, I used subs and learned that it was like heroin, but that unless there was a steady supply of it, the after effects were much harsher. Because the availability of subs was precarious for me in prison, I used other drugs. However, because suboxone is so easily smuggled into prison, I knew other people had a steady supply, and those that used it most frequently feared what would happen should they lose the ability to use the drug. They told me the withdrawals last 30 days, rather than a week as it is with heroin.
I only learned that suboxone was like methadone after I left prison and was in recovery. In early recovery, I felt that even if I were able to use the suboxone, it would immediately lead to my life being torn to shreds. I learned later that it was the medication typically used for detox. I’d never detoxed off opiates anywhere but in a jail cell. So, I understood at once that suboxone tapers were beneficial to many people, because it alleviated much of the pain of withdrawal. However, I knew as many people do that there is an extreme potential for suboxone to be used merely as a substitution for heroin. That essentially there would be little difference between one drug and the other.
In recovery-based fellowships there have been and are numerous arguments related to whether someone on suboxone is can be considered abstinent from all mind or mood-altering substances. There are policies and ways each individual fellowship views on medication. Even more to the point different groups have different opinions on the subject. There are also different views on what recovery is. A definition I have heard is; a person can be seen to be in recovery if they say they are in recovery, however the efficacy of that recovery plan may be questionable. For instance, if a person weren’t involved in a fellowship, used suboxone to the degree that they were perpetually high, and incapable of functioning in day to day life, their recovery might be questionable, in the opinion of most people.
A person’s recovery is generally based on how well they
function in day to day life and on how well they live life on life’s terms. So, a person using suboxone beyond what is needed for a detox, may have their recovery questioned, if they are largely incapacitated. Given the numerous side-effects and potential for opiate dependency that can occur with suboxone use, these are legitimate concerns.
Additional fears related to the fact suboxone seems to simply be a re-packaged and re-branded narcotic have also been expressed. It is also true that buprenorphine one of the components for suboxone is still used for pain relief, for people who are no longer affected by other pain killers. So, there are very real concerns that suboxone is just a narcotic. If suboxone is a narcotic it should be viewed and treated as especially dangerous to anyone that has substance use disorder. Still, the effectiveness of suboxone for detox has been shown in numerous studies, which lends legitimacy to suboxone as a treatment option.
What is Vivitrol (naltrexone)
Vivitrol blocks the effects of opiates such as heroine and reduces the urge and desire to consume alcohol. Vivitrol blocks all the narcotic effects of opiates including the relief from pain that opiates are often prescribed for.
There are two methods of receiving vivitrol there is both the pill form as well as the intramuscular injection. Naltrexone should not be taken during the withdrawal period, or while a person is taking opiates such as suboxone, because it can cause sudden withdrawal symptoms for someone that is dependent on opiates.
Naltrexone does not cure substance use disorder (addiction or alcoholism). Studies do suggest that when vivitrol is taken in conjunction with long term treatment it does help individuals find their path to recovery.
Issues related to Vivitrol
I only recently became aware of vivitrol after I began working in treatment. I have heard from people who have received it is that they felt sick after taking it. Although, they did not indicate if this is from the vivitrol shot. Nor did they state they felt sick because they had chosen to get the shot before fully withdrawing from opiates. Individuals I knew who decided that it wasn’t for them made that decision before taking the shot. Those individuals who didn’t take the shot relapsed shortly after making that decision.
It’s suggested that you be off opiates for two weeks before receiving the shot. Having to wait for the shot may be an issue. That means that a person receiving the vivitrol shot should generally be in treatment before being given the shot.
A person needs to have undergone a detox before being administered the vivitrol shot. This is the most obvious problem. However, this is resolved by going to a detox facility. Detox facilities are also beginning to discuss how quickly a person can be put on vivitrol. Some facilities are also letting people choose other methods of detox than an opiate based detox. Which, allows an addict to go on vivitrol much more quickly.
Vivitrol v. Suboxone?
There are articles online that look at the two medications as opposing forces on how to deal with drug treatment. Arguments persist, and studies persist on indicating that it is one way or the other. A person either takes suboxone or vivitrol. These arguments do not consider that there are treatment methods that combine the two. For instance, a person might detox using a suboxone taper and then get the vivitrol shot afterwards.
The studies that compare the two are frequently self-reporting as well. I know that the last opiate I did was suboxone. That was an abuse of the medication and it is quite easy to abuse a medication you are prescribed. Suboxone shows up as buprenorphine on a drug test. So, it would be difficult for someone to tell if a person on were abusing suboxone.
With vivitrol it’s easier to determine if someone relapses, mostly because they must stop taking vivitrol to use opiates. Vivitrol is not a magic shot that cures addiction. But vivitrol does help to keep someone new to recovery in check. It should not be used on its own.
Suboxone has a stigma attached to it. Because, people who use it to treat heroin/opiate addiction are still chemically dependent on a narcotic. However, many people do use it with the intent of slowly weening themselves off suboxone. They use suboxone with a doctor’s help, so they can detox outside of a facility. Those individuals will often argue that they are alive only because of suboxone. Some people even argue that they’re continued use of suboxone allows for them to function in day to day life.
Personally, the people I know with long term recovery, who are incredibly successful are abstinent from all narcotics. Admittedly, my experiences with suboxone abuse colors my perspective to see the drug in a negative light. So, it should only be used during detox, where a person is rapidly tapered down off suboxone. Vivitrol can then be administered a couple of weeks after the detox period. If a person is in a long-term treatment program, their chances of long term recovery are increased exponentially. This is how I would like to have been treated for my addiction and how I would have liked to be introduced to early recovery.
I don’t think that it’s a matter of vivitrol versus suboxone. It is also not an issue of medically assisted treatment versus rehab. It’s counterproductive to think that different forms of treatment should be seen entirely in opposition. I believe there are ways they can all be combined to help a person find long-term recovery. Ultimately, once a person detoxes and is free from active addiction, the choice to use is dependent upon those of us dealing with addiction.
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