July 19, 2016, by Jerry Nelson – The U.S. Veteran’s Administration has been under fire in recent years for poor health care to our nation’s veterans. Long appointment times, no one manning the suicide hotlines and prescriptions which take weeks, or months, to fill.
It’s not all bad news though. The VA recently announced that it will make Vivitrol available to veterans who are battling substance abuse. The medication, which costs civilians about $12,000 a year, is available now at larger VA Hospitals and should be available by 2017 at rural, outlying clinics. Until the latest announcement Veterans Hospitals have been using methadone as a form of codeine treatment to address withdrawal and related issues.
Vivitrol, which comes as a monthly injection meant to treat opioid dependence, has gotten off to a slow start. It is slowly proving useful in helping certain patients say doctors familiar with the drug extended-release naltrexone – sold under the trade name, Vivitrol.
Vivitrol’s approval gives substance abuse rehab programs an alternative to daily methadone administration, which has been the standard for addiction to heroin or prescription pain medicines. Both drugs suppress withdrawal and cravings, but many people find it challenging to stick with a daily treatment. Missing doses can lead people to relapse and since buprenorphone is taken at home, it can be sold on the street.
Vivitrol is an opiate antagonist. This means it blocks the opiates effects by filling the opiate receptor sites in the brain. Methadone is an agonist which works by mimicking opiates in the brain.
Dr. Herbert Kleber, Director of Substance Abuse at the Columbia University College of Physicians, says, “My patients claim that each time they get a tablet in their hand, they get a craving. You don’t remove that feeling with Vivitrol, but at least you’re pushing the craving down the road for thirty-days.”
According to Dr. Kleber, the best potential candidates for Vivitrol, include persons who have been battling opioid addiction for less than a year. Persons who have been addicted for over a year may find that Vivitrol is not enough.
Vivitrol can also be used for people in jail or in prison, however, most Departments of Corrections don’t appreciate Vivitrol as the DOC considers it as replacing one narcotic for another; a mistaken belief which shows how misunderstood Vivitrol often is.
Professionals who are in substance abuse treatment, such as nurses or physicians, may find Vivitrol an option if their treatment must be supervised. Other candidates include patients coming off methadone and those at high risk for relapse during the first few months.
Kleber tells persons that if they choose buprenorphone they may be on it for years while an individual’s length of stay on Vivitrol varies. “For someone with good things going for them, such as education and job skills, then six months may be a good number to shoot for,”Kleber says.
A big issue with Vivtrol is the cost – roughly $1,000 a month. Many patients with private insurance may be eligible for reimbursement up to $500 a month for their copay. Although Vivitrol is expensive, so are the alternatives.
It may cost $55,000 to house someone in prison for one year. Compare that to about $12K a year for Vivitrol.
Vivitrol may be used for other types of dependence in the future. At the recent American Society of Addiction Medicine, researches presented data about time-release naltrexone for nicotine dependence as well as amphetamine and methamphetamine.
“It’s a medicine that is getting a lot of attention. Hopefully it will open more therapeutic possibilities,” says Kleber.
Author Bio: Jerry Nelson, a Vietnam Veteran, is an American writer and photojournalist and is always interested in discussing future work opportunities. Email him at firstname.lastname@example.org and join the million-or-so who follow him on Twitter @Journey_America.
* Photo by ALYSIA SANTO/THE MARSHALL PROJECT.