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  • BDD Moderators: Keif’ Richards

Not sure if Vivitrol is the way to go?

Y

yo0123yo

Bluelighter
Joined
Jan 22, 2009
Messages
506
Location
Malibu, California
So I have been opiate dependent for quite some time (2+ years) and recently started seeing a pretty good psychiatrist, out of all the psychiatrists I have seen, he was the first to let me know about something called Vivitrol which sounded amazing. The thing is now I am on Suboxone 8/2mg 3x a day and it is pretty annoying to have to keep dosing every day, he mentioned that the Vivitrol shot is once a month and your good..My insurance won't pay for the Vivitrol shot so I would have to pay cash but if it is that much better then I would much rather do that. I guess what I'm trying to ask is should I get off of Suboxone and just take the Vivitrol? I thought Vivitrol didn't kill the withdrawal?
 
Vivitrol is just a once-monthly injection of time-release naltrexone, an opiate-antagonist. It will provide NO opiate effects, and will block any effects from any other opiates you would take on top of it - that long-lasting opiate effect blockade is what makes it a good drug for those who really want to be OFF all opioids, and DO NOT want maintenance therapy such as is with Suboxone/Subutex (buprenorphine) or methadone. If you really want to get off all opioids, even those for maintenance therapy like your current Suboxone, I'd first recommend tapering that until you are off and probably wait until those wd's would be over - not sure if Vivitrol (naltrexone time-release injection) would throw you into wd's from buprenorphine, though, so I am not exactly sure if you'd have to wait until all wd's would be over, but you'd still have to face wd's one way or another. Naltrexone can be a very good drug in theory, and can be taken by oral tablet, too, but it depends on where your comfort level with a full no-opioid life sits and will sit. If you want to try naltrexone, I'd recommend trying the oral formulation first - otherwise the Vivitrol would keep you unable to feel an opiate for the likes of probably at least a month (hence the monthly injection).
 
Wd's of buprenorphine in Suboxone? If you are referring to the naltrexone, I honestly do not know if it causes, and to what extent, precipitated wd's if you are opioid-dependent and take it while taking another opioid. It may vary on the other opioid. For example, that is why I question if the Vivitrol would really cause much effect on the buprenorphine wd's because naloxone, another opiate antagonist in Suboxone with the buprenorphine, usually will cause precipitated wd's but with buprenorphine, the buprenorphine is binds more strongly to the opioid receptors and the naloxone doesn't really mess with it. To be honest, I do not know what the naltrexone in Vivitrol would do, but like I said, if you elect to take it, do not expect to be able to feel anything from other opiates. Naltrexone in Vivitrol is NOT like buprenorphine in Suboxone/Subutex - naltrexone is a FULL antagonist and will block the opiate receptors function, but buprenorphine is a PARTIAL antagonist and also a PARTIAL agonist which is why it causes the opiate addict to remain "well" or "well enough" while taking it but still blocks other opioids. Naltrexone will just do the blocking - it will not take away any wd's, it will not keep you "well" like buprenorphine, but rather simply make it impossible to use other opiates and have them render effects as well as sometimes cutting down on cravings a bit. You will need to get off buprenorphine at some point, if you are going to be taking naltrexone - they are VERY different drugs.
 
Will Vivitrol cause precipitated withdrawals for someone who is on Suboxone? This is a very good question. The prescribing info says "Unintended Precipitation of Opioid Withdrawal: Opioid-dependent and opioid-using patients must be opioid-free for a minimum of 7-10 days before starting VIVITROL treatment". BUT, as mentioned, buprenorphine is unusual, it has a higher binding affinity than naloxone, so injecting a small amount of naloxone (like the quantity present in Suboxone) does not induce precipitated withdrawal, but I'm not sure about naltrexone (the ingredient in Vivitrol). I think it can induce precipitated withdrawal, at least I know that monkeys dependent on buprenorphine went into precipitated withdrawal when given naltrexone. Plus there is a lot of naltrexone in the Vivitrol injection.

Vivitrol will not alleviate withdrawal. What did your doctor say about it that made it sound amazing?

The majority of people I know who were on naltrexone hated it and stopped taking it if it was in pill form or dug the implant out of their arm when it was the implant - with Vivitrol you can't do that since it's an injection, so you're stuck with it. It's only function is to make you unable to get high from opioids so you are theoretically less likely to succumb to cravings knowing you won't get high. Studies have found it does not decrease cravings.
 
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I thought binding affinity went bupe>naloxone>naltrexone. I know people IV'ing subs while on vivitrol and saying they get high. also vivitrol is a depot kind of shot, an oil that slowly releases naltrexone so its not a monster dose all at once. also remember antagonists block endorphins too. I was on the pills and it made me feel "off" and depressed. try the pills in case you don't react well to them you won't have to suffer for one month. personally ill never touch naltrexone unless its ULDN.
 
Serotonin101 said:
I thought binding affinity went bupe>naloxone>naltrexone. I know people IV'ing subs while on vivitrol and saying they get high. also vivitrol is a depot kind of shot, an oil that slowly releases naltrexone so its not a monster dose all at once.
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Yeah, that's probably right, I just meant that the amount of naltrexone in Vivitrol is not really comparable to the small amount of naloxone in Suboxone, so just because injecting Suboxone doesn't throw people into precipitated withdrawals doesn't necessarily mean that getting a Vivitrol shot while taking buprenorphine will not. Just because bupe has a higher binding affinity than naloxone and naltrexone doesn't mean that the effects of bupe can't be reversed by naloxone/naltrexone, it just takes more than it would for a regular opioid. I would definitely ask a doctor (or 2 doctors if the prescribing doctor doesn't seem knowledgeable enough) about the protocol for switching from buprenorphine to Vivitrol and the possibility for precipitated withdrawals. I have not personally heard of anyone switching directly from Suboxone to Vivitrol without waiting weeks in between. Also, even if it doesn't cause precipitated withdrawal, a person is still going to get regular withdrawal from quitting bupe since Vivitrol does nothing to alleviate withdrawal.

Serotonin101 said:
try the pills in case you don't react well to them you won't have to suffer for one month.
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This is a very good idea.
 
Ok so this is what will happen. Your doctor/councilor will start putting you into "weening off" mode if you're on the agonist route right now (methadone, sub, bupe), and then when they think they've gotten you down to a sufficient level, they'll slowly feed you a naloxone pill, in quarters, slowly over a day. They're making sure that you truly are cleaned out enough so you won't get any precipitated withdrawals from the big shot. If that's all clear, they give you the shot. And from what I've heard and read (which is A LOT), it has an effect on you that is hard to fathom until you do it: you lose all desire. someone could put it right in front of your face and you just shrug your shoulders and go, "nah." That's in addition to it blocking you from feeling it even if you did. A lot of people also report it makes cravings and thoughts and urges about it go away. Also works for alcoholism and is being tried out for cocaine. Fucking wonderdrug.
 
If you are on Subs (Bup), you will have to ween off/quit cold turkey. Despite the fact that Bup had a higher affinity than Naltrox, the shot will INITIALLY knock the Bup off of your receptors, causing precip WD.

I have found Vivitrol to be an awesome medication for me. I was really ready to quite, the pills worked for a while, and while I had several month periods of sobriety, one slip up could lead to a huge fall within a matter of days. I look at Vivitrol as my third line of defense, beyond counseling, staying smart about people/place, etc... it is if I come into contact with opiods, don't have the willpower to stay away, then it won't matter as they won't effect me anyway.

Just as a head up, when my monthly bill comes, it is over <snip>. My insurance covers it (I think they also have an assistance program, so look into that). Depending on where your located, you may be able to find a doctor who can get it for much less, or may even be involved in trials for it which allows them to administer it to you for free/steeply discounted, so long as you are a participants.

Good luck
 
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K10dunst said:
And from what I've heard and read (which is A LOT), it has an effect on you that is hard to fathom until you do it: you lose all desire. someone could put it right in front of your face and you just shrug your shoulders and go, "nah." That's in addition to it blocking you from feeling it even if you did. A lot of people also report it makes cravings and thoughts and urges about it go away.
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Did you hear this from actual people who were on it? Everyone I've talked to who tried any kind of naltrexone therapy said the only way it helps with cravings at all is that you know there is no point in acting on them. It's not uncommon for people to use opioids anyway in a desperate attempt to overcome the blockade, to refuse to get their next shot, and to dig naltrexone implants out of their flesh with a razor blade, (obviously you can't do that with the injection but I mention it to illustrate my point). So I would not say it eliminates desire or cravings to use. It is effective for a very specific group of people in combination with things to help with their mental addiction like supportive therapy, meetings, support from people in their life and stability in their life situation, etc. But it is not a "wonderdrug".
 
^^didn't someone post a thread about getting ready to dig out their implant a while ago? I just remember reading it and saying "holy fuck!"
 
Swimmingdancer said:
Did you hear this from actual people who were on it? Everyone I've talked to who tried any kind of naltrexone therapy said the only way it helps with cravings at all is that you know there is no point in acting on them. It's not uncommon for people to use opioids anyway in a desperate attempt to overcome the blockade, to refuse to get their next shot, and to dig naltrexone implants out of their flesh with a razor blade, (obviously you can't do that with the injection but I mention it to illustrate my point). So I would not say it eliminates desire or cravings to use. It is effective for a very specific group of people in combination with things to help with their mental addiction like supportive therapy, meetings, support from people in their life and stability in their life situation, etc. But it is not a "wonderdrug".
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For me... my cravings aren't 100% gone, but they are pretty well curbed. However, I'd say take this with a grain of salt, as the above poster mentioned, there are plenty of ppl who get the shot/implant/pill/etc, and they can't wait to use again! For me, I know how much better I am when I am not using. I just can't do it. And trust me, like many of us, I've tried. With that said, my lack of cravings might have nothing to do with the shot, rather just being sick and tired of being sick and tired and not wanting to go through the pain of addiction anymore. If you have any specific questions for me about my experience or whatever, feel free to post them (while I come on this board every now and again, I don't think I can yet to PMs, so feel free to post here and I'll try to remember to return here over the next few days). There are some weird side-effects I sometimes have, but nothing close to making me want to stop the shot. For example, I hate needles, and its a decent sized one, so I do get pretty anxious in the hour or two leading up to the shot. It sometimes messes with my stomach for a day or two, tops. Also, following the first several days after the shot, if I contort my butt cheeks in a certain way, or sit directly on it, I swear I can TASTE the shot. I've mentioned this to several ppl, none of whom are surprise, as we are all certain that the shot excretes somehow, and experiencing a taste (it is actually more like a smell that I taste, if that makes sense...) is a likely possibility. Others, however, have no reported that. FYI, I'm just over a year on it.

Sorry about my previous price post... lets just says it is not cheap (but cheaper than my addiction!)
 
it makes sense taste a smell. I'm sure most of us IV drug users remember that experience when getting high. I personally hated naltrexone. too much endorphin suppression for me and I became extremely depressed. I got off ASAP. I wanted to use while on naltrexone as the depression was triggering.
 
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