Opioids WTF Naltrexone / Vivitrol? Why the new push?

[speedballs_over]

I've noticed a big increase in the number of people on here discussing Vivitrol [i.e., naltrexone formulations, the new extended release injection is a newer formulation taking on an old trade name]

This compound is not the same as the active compound in Narcan, that compound is naloxone as the HCl salt. They are both full antagonists. They are not identical, naloxone is major tool for harm reduction in the form of an extremely effective OD reversal agent. Naltrexone is more of a pharmaceutical in the sense of being used for longer term treatment.

Naltrexonoe has been around for a long time. I see that the manufacturer of Vivitrol has a newer web site up. My guess is there's a new marketing push to use this compound to "treat" opioid dependence.

This compound has been used in various forms for decades without gaining much traction. There's very probably a good reason why.

I'd like to hear from someone who has gone the naltrexone route and now has a year or more of abstinence from all opioids. What was the experience like? Would you recommend it to others?

Is anyone who is starting naltrexone in the near future going to be having the older implant formulation? I'm curious if treatment programs are still pushing the implants.

I recall many "overnight detox" programs - another terrible failure and one that killed a few people at least - used naloxone/naltrexone preparations to induce precipitated withdrawals while the subject was unconscious. Those detox programs were often described as hell or worse, and I don't hear much about them anymore here in the US. I suspect this is just another round of pharma trying to push naltrexone to unsuspecting physicians who want to cash in on the wave of addiction treatment. Cynical... perhaps.

What I don't get is why anyone would allow themselves to be injected with this shit, other than out of desperation to have a blockade of some sort. I'd understand that desperation, for sure, but to choose naltrexone (or any full agonist)? I usually have seen this compound used in coercive programs like in-patient re-habs and court ordered programs. Voluntarily? I think that would be a new trend (other than the previous use of antagonists in "overnight detox" cocktails). I'm guessing it's pharmaceutical company marketing, and will - again - prove to be an unpopular, ineffective treatment over the longterm. Sure, some will find it useful and have success with it, but if history is any predictor it will fail to match agonist/partial agonist medicated therapy in long term efficacy, as measured by sustained no/minimal relapse to illicitly obtained opioids.

I've known people - more than a few and personally - that have ripped out naltrexone implants, but none recently. That was more of a 2000s thing. Can't really rip out the bolus injection. That'll ensure more "success stories" but will they be genuine, will it prove effective and popular as a treatment? Or will it be again revealed to be a hellish way to treat oneself in the wake of opioid dependence.

Not at all an attack on anyone choosing this option for dealing with opioid dependency, I just don't get it. More so I'm worried about this trend of pushing full antagonists to treat people with serious cravings and nasty habits.

I'm a decade into recovery from IV heroin, used methadone and still take a modest does of bupe. I work in harm reduction and where I work we generally regard naltrexone as poison and any medical professional who would suggest it as treatment to be either naive or dismissive of opioid dependency as a serious mental disorder. We'd never tell someone not to try it if they wanted to, but if they ask we sure as hell warn them about how they may fell after having the shot. We deal with a lot of emotionally unstable people and people with mental health co-morbidities along with opioid dependency.

It's my belief that naltrexone may exasperate the depression that often follows from opioid abstinence in those who are dependent and generally cause a prolonged PAWs type syndrome.

 

[Tommyboy]

I think that they are pushing naltrexone more now since a lot more people are in treatment and the doctors can only prescribe subs toa certain number of people. They are cracking down on these doctors so they would rather not deal with it.

Some other reasons are that a lot of people don't want to go from being dependent on one substance to another one. A lot more people know how hard it is to kick suboxone now so they would rather try to avoid it. A lot of people hooked on heroin and painkillers are depressed by the thought of being dependent on a opioid still so why not try an alternative?

Suboxone has caused a lot of people to have a worse kick than if they had just kicked the dope, and since it's common knowledge how hard it is to get off subs then I don't blame people for going that route, at least for a little while.

I want to point out that although naltrexone and naloxone are different drugs they both will still cause you to experience withdrawals if you take it too soon so give yourself a week free of opiates before getting on naltrexone, and 10-14 days if you are getting on it from suboxone or methadone. There is no rush to take it as it's not going to help with your withdrawal symptoms and precipitated withdrawals are still really bad even after being clean for 5 days so be patient. I'm talking from experience there so don't think I'm just saying that based on what I heard from others.

 

[Screaming_Skull]

I dunno, but I sure as hell would never do it...doesn't it just BLOCK opiatates, not like Subs or methadone where it actually helps cravings...I think I've read about people even taking the implants out themselves because they couldn't deal with craving and got suicidial because of PAWS. So HELL NO. I would just maintain on Kratom/Pods/Seeds/Immodium than this crap, or find a shady doctor,or go back to buying on the street. But fuck that shot, that's all I gotta say.

 

[speedballs_over]

Does anyone with longer term experience* have anything good to say about naltrexone? This is a serious discussion I'm trying to get going b/c I feel very strongly that naltrexone is not harm reduction "best practices."

It can always be argued that an antagonist administered in an out-patient clinical setting is HR b/c it provides blockade, but at what cost? And so is it HR at it's best, or is it just another compound that can be successfully marketed and sold - the only outcome most pharmaceutical companies give a shit about? In general the pharma industry is not concerned with post-marketing adverse events.

Tommyboy - thank you for the thoughtful reply.

As I mentioned before, I have experience helping people in the wake of tearing out an implant of naltrexone. Some relapsed after tearing out the implants, some did not. It wasn't always about getting high again, some had been in treatment a long time and did not like the feel of/emotional fallout from naltrexone and just wanted it gone. Then they carried on with their recovery - I don't have every outcome at my finger tips, I wish I did, although it would be a statistically irrelevant sample in size and make-up.

That is precisely why I am asking for more experiences from as broad an audience as I can get in a hurry. My experiences are not definitive, not one bit.

I would like to see less regulation of bupe prescribing, patient limits are harmful to the general population. I'll stop there, I want to keep this focused on naltrexone.

Screaming_skull - I'm with you on this, obviously. "taking the implants out themselves because they couldn't deal with craving and got suicidal because of PAWS." - that's exactly the type of thing that I'm concerned about. They (the manf) figured out that implants won't work, they know this, I'd like to see the internal company memos and development documents regarding the new formulation. Why change the formulation if the old one worked? It's terribly expensive to develop a new delivery mechanism, even for a previously approved compound. The compnay obviously saw a market for this formulation, but does that make it good medicine?

I fear there will be more suicides and people suffering from PAWs or depression alone if this compound continues to be used in rising numbers.

*I'll take six months as long term... please if you have used naltrexone implant, tablets** or injection for six months tell us about your experiences, otherwise people can dismiss this discussion as worthless.

 

[Screaming_Skull]

Ya, the paitent cap on Suboxone patients is bullshit, you can have all the pain patients you want(I think??) but only 100 Sub patients?? Luckily, I got a doctor on my 2nd call at some pain clinic(I'm assuming since theres a Methadone clinic very nearby, and this is a pain clinic, not many people are asking for Subs in that area)Same goes for methadone clinics,all the waiting list, just pisses me off. But sorry I'm derailing the thread....

 

[tacodude]

I do remember an old study that found it to reduce the development of physical dependency of opiates when taken alongside..... I came across it in the shroomery news I believe.

 

[speedballs_over]

People have experimented with "micro" dosages of full antagonists alongside of full agonists to delay/prevent tolerance. Quite a bit of excitement about that in years past, haven't heard much recently. That would qualify as HR info, imo, reducing the qty of opioid needed to satisfy pain relief needs or to deal with a "illicit" habit with less cost.

I guess we could expand this thread to include possible other uses for antagonists. It ain't going anywhere fast as it is...

But really folks I'd love to hear about successful naltrexone outcomes when used to treat opioid dependency. I'll try to legitimately keep this going until we hear from those folks - i.e., without bumping this in a self-serving, anxious fashion.

 

[tacodude]

I'll try to clarify. While I have no clue how it changes effectiveness of pain management it is supposed to prevent the development of physical dependency symptoms. I am not sure if it also applied to tolerance development.

 

[whereAREyou?]

I've had the the vivitrol injection seven times and have mixed feelings with it but I have some things to share.

I was first introduced to the drug in an in-patient 30 day treatment facility. They had some form of relationship with this sleazy Vivitrol sales rep guy and what would happen is every week family could come visit, lets say it was on a thursday. So thursday afternoon, this Vivitrol sales rep would bring a catered lunch to the whole staff (NOT the patients), like chic-fil-a. Then that evening when all the families came we would have an hour to talk with them and then we would HAVE to leave. This is when sleaze-ball vivitrol rep came in and gives the family members this big spill on how great vivitrol is and yada-yada. So obviously the rehab was getting big kick backs for getting people to take this shot which I think that whole situation is manipulative as fuck. But whatever. So after this happens (it was my mom who came and visited me), my mom gets on this big kick that I need to get this shot, its my last hope. And honestly at this point in my life I was very open to sugestions so I ended up getting this shot.

Long story short, I get six injections (I was also getting involved with AA, going to meetings, doing some.. step work, thats a different story for a different post btw) and stayed completely clean and sober from EVERYTHING (no suboxone, alcohol, etc) this entire six months. I decided I had been clean long enough and decided I would discontinue the shot and ended up relapsing (on alcohol on vacation..eventually leading back to IV heroin use). I'm currently back on the vivitrol shot and about 20 days clean/sober. And honestly, since i've been sober a good part of the last year, its been a great fucking year. I got a job that I had been trying to get for years, I'm back in school (just started 3 weeks ago) and honestly I'm the most productive/independent/responsible i've ever been in my life. So has it been worth it? I'd say so.

And I'm not too sure why people are suggesting that its torture and "OMG poor you, your parents MADE you get the vivitrol shot." No one can make you get the shot, my guess is someones parents said your getting this shot or your getting cut off and said person made the most logical choice.

As far as side effects, i've had very little. The biggest one for me is with sleeping but I've seen gotten a sleep med to take at night if I need it. Its more so not being able to stay asleep, falling asleep has been no problem. I do understand that everyone is different and different people are bound to have different side effects.

Some of you may be asking yourselves, why did he say he had mixed feelings about it...? He's been mostly positive towards the drug with the exception of some minor side effects. The answer to this question is, I can't get high & and well, sometimes I wanna get high. But this is the beauty of the drug, I know I can't. I would highly recommend using AA/NA along with the injection.

Anywho, thats my two cents. Let me know if you have any questions I could answer. Its a relevant topic to me.

Thanks guys.

 

[lolwhatzdrugs]

Damn.


Two seconds on the FDA Website:


This is in the section IMMEDIATELY after describing it's indication for alcohol addiction. - what a joke. If naltrexone helps you and you have liver disease probably best not to get depot injections.

Hepatoxicity

Naltrexone has the capacity to cause hepatocellular injury when given in excessive
doses.
Naltrexone is contraindicated in acute hepatitis or liver failure, and its use in patients with
active liver disease must be carefully considered in light of its hepatotoxic effects.
The margin of separation between the apparently safe dose of naltrexone and the dose
causing hepatic injury appears to be only five-fold or less. VIVITROL does not appear to
be a hepatotoxin at the recommended doses.
Patients should be warned of the risk of hepatic injury and advised to seek medical
attention if they experience symptoms of acute hepatitis. Use of VIVITROL should be
discontinued in the event of symptoms and/or sign of acute hepatitis.

WTF do you mean apparently?

WTF do you mean discontinued? They cut it out of your fucking arm? And then anything that has already been stored in the fat tissue keeps killing liver cells? It's not a fucking pill!

 

[Timland]

I once took 50mg of Naltrexone accidentally TWO days after using poppy pod tea.

It was the worst 22 hours of my life both physically and psychologically. Precipitated withdrawal which is many factors more intense than normal withdrawal.
The last 4 hours were the most agonizing, every muscle and tendon on fire as I worked up the strength to break down poppy pods into a flour and break through for relief. That was in 2011.

 

[jdaen]

I realize this is bumping a year old thread and I'm sorry about that, but I see the OPs question was never answered.

I have had the Vivitrol shot a few times and it was actually extremely helpful. As a first line of treatment to someone not dedicated to being sober, this is a horrific idea. As previously stated, it's bad on the liver, and people will often dose higher and higher to overcome the blockade, which is really dangerous. For me, it helped in specific situations.

When I first went to treatment, I was put on subs and had the dose quickly reduced to make detox more comfortable. I finished treatment and stayed in the state I was in (not my home state) for about a year. In that time, I got involved in NA and developed a support system that over time, diminished my cravings for opiates. When I decided to move home, I knew I would no longer have that support and it would take time to reintegrate into NA (find a home group, make friends, etc.).

I got the shot before moving and for 6 months after as a failsafe... An insurance policy of sorts. It made it so that if I did feel a moment of weakness, I knew I couldn't get high even if I wanted to. Knowing that made it easier to get through passing my old dealers house, seeing old friends, what have you. There were times I wanted to use but knowing it would be pointless pulled me through the winter (historically, the most difficult time for me).

Once I was more stable in my setting, I elected to stop getting the shot. I had no negative effects from it and may have stayed on it were it not for a surgery I needed to have, and the difficulty managing pain while on it.

Though I have heard horror stories, mine was only positive.

 

[Nether Animal]

I once took 50mg of Naltrexone accidentally TWO days after using poppy pod tea.

It was the worst 22 hours of my life both physically and psychologically. Precipitated withdrawal which is many factors more intense than normal withdrawal.
The last 4 hours were the most agonizing, every muscle and tendon on fire as I worked up the strength to break down poppy pods into a flour and break through for relief. That was in 2011.

I have a buddy who took his naltrexone way too early. The doctor told him to wait about 4 days and he thought he said 4 hours (for whatever reason). He actually popped it and left the house to go to the bank, and collapsed in the bank parking lot and ended up on a ventilator for nearly a week in the ICU.

 

[Rachella666]

It saved my life when I overdosed last year so I'm all for it.

 

[shadowstryker]

Ya, the paitent cap on Suboxone patients is bullshit, you can have all the pain patients you want(I think??) but only 100 Sub patients?? Luckily, I got a doctor on my 2nd call at some pain clinic(I'm assuming since theres a Methadone clinic very nearby, and this is a pain clinic, not many people are asking for Subs in that area)Same goes for methadone clinics,all the waiting list, just pisses me off. But sorry I'm derailing the thread....

I agree with this. I told the doc while I was in rehab there was no way in hell I'd take Vivitrol shots monthly despite him the psych and physician all really trying to push it on me. I rejected it because once I'm past my contract of weekly drug testing (about 4-6 weeks) I plan on using again but that's besides the point. I told him I was afraid if I'd relapse I'd OD and die (very real possibility with Vivitrol), but I asked for suboxone and he said it was highly unlikely I'd find a doc to prescribe it to me. Well, several days of annoying him and he finally found one, so I'm now taking Zubsolv.

It was mainly because I wanted something to give me a buzz while I'm being forced sober as currently all I have is psychedelics and kratom that I ordered coming in soon because I was forced to sign a contract saying I'd attend IOP/NA meetings 3x a week and submit to weekly drug testing, but it does help with cravings. Still really miss my dope though.

 

[PINKoPANaTHER]

I think the people posting who have only gotten sober using it may have bias introduced to them. Naltrexone can blockade your endogenous endorphins, and I spent 6 months getting sober with it, and over a year without it after relapsing. I felt miles better without it, which was even more encouraging for getting sober, as I was expecting the protracted nightmare of naltrexone (I both times went cold turkey off subs at 8mg+ doses). Without the naltrexone, I was able to exercise, do productive things, compete, and laugh, all things that increase endorphins, and I actually felt really good after these activities, which lead to my exercise and competition addictions (much better than opiates). On naltexone I just felt like I was getting through the day, only to wake up feeling the same, and ended up in a mental hospital for suicidial issues, where I stopped taking it and did better for a while. People respond differently so I won't say this will happen to everyone, but for me, sober meant sober, not artificially aided sobriety with the antabuse of opiates coursing through my veins.