In our previous blog post, we did a general breakdown of medical treatments for opioid use disorder. Today, we want to discuss two specific medications in depth, naltrexone and buprenorphine.
Naltrexone is an opioid antagonist, also referred to as an opioid blocker. It can be taken orally every day or injected monthly. The extended-release naltrexone shot, called Vivitrol, was approved by the FDA in 2006. The Vivitrol shot was the first addiction medicine given by injection.
Addiction Medicine Rundown
With Vivitrol and psychosocial support, addiction treatment can effectively reduce drug and alcohol cravings, ensure medication adherence, and protect struggling patients from relapse, or death by overdose. Vivitrol is administered intramuscularly in the buttock, alternating sides each month.
There is one big obstacle for Vivitrol. Before initiating this medication, the recipient must be opioid-free for 5-7 days to avoid opioid withdrawal symptoms. Though this may seem impossible, our team can help achieve this by utilizing non-opioid medications to help detox. These medications treat specific withdrawal symptoms (including but not limited to anxiety, restlessness, insomnia, nausea, etc).
Like naltrexone, buprenorphine can also be taken orally every day or injected monthly. The FDA approved the buprenorphine shot, called Sublocade, in 2017. Sublocade is administered subcutaneously in the abdomen, rotating through the four different regions of the abdomen each month.
Sublocade differs from Vivitrol in its molecular makeup. It is a partial agonist rather than an antagonist. This means the body becomes accustomed to it. Anyone on the Sublocade shot, or any form of buprenorphine, will have to endure some discomfort to discontinue the medication.
To help us illustrate further, consider the following analogy:
Say you want to buy a car. Buprenorphine is like leasing a car. You would be able to enjoy your new car right away, but you still have the bank to answer to each month as you work to pay it off. At the end of the lease, you still do not own the car and have to go through buprenorphine withdrawal. Naltrexone is like saving up your money for months and paying cash for the car. It is more work upfront, but you own the car and do not have to pay a cost at the end of the lease. Utilizing Suboxone, or buprenorphine helps you to stabilize quickly. Still, you may feel some anxiety looming about the inevitable discomfort that detox brings. Initiating treatment with Vivitrol or naltrexone is more work in the beginning, but you own your recovery and never have to worry about the discomfort of withdrawal or detox again.
When utilizing medications, our office understands these differences and works with each patient to determine the best option for them.