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It is time for someone to say this out loud. “We should not use opioids for back pain.”

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Vivitrol is killing people.

June 26, 2017

I blame the pharmaceutical industry for the opioid epidemic and for the tens of thousands of deaths it causes every year. Of course, there are other players to blame as well. Physicians – including myself – believed Big Pharma instead of looking at the literature ourselves. We also prescribed too many opioids, resulting in this plague of addiction, overdose, and death. Nonetheless, the pharmaceutical industry is the main culprit and continues to value money over people – and profits over lives. 

 


Alkermes is a pharmaceutical company that produces Vivitrol®. This is a long-acting, injectable medication that blocks the opioid receptor. Along with buprenorphine and methadone, it is one of three medications used to treat those with opioid use disorder (OUD). Vivitrol works by completely blocking the opioid receptor. If someone has received a Vivitrol injection and takes an opioid any time in the next 4 weeks, they will feel no effects from the drug. The opioid receptor does not function when blocked by Vivitrol.


Alkermes is heavily marketing Vivitrol to legislators in statehouses across the country. 
Vivitrol does have its place in the treatment of OUD - but that plac
e is very limited. This is because Vivitrol does not work for most patients. In a “real world” study out of Los Angeles County, CA, 171 individuals presenting for treatment of OUD were started on Vivitrol and also received psychosocial treatment. By the sixth month, only 8 remained in treatment (see chart to the right). Two had died of an overdose (Cousins et al., 2016). Those who drop out of treatment are not cured of their disease. The great majority relapse. Methadone and buprenorphine are both much more successful in retaining people in treatment. 


Many states have paid attention to the Alkermes lobbyists and developed rules and passed legislation that favor the use of Vivitrol over other medication-assisted treatments. People are dying because of this. To mandate the least effective treatment for a life-threatening disease both lacks common sense and is irresponsible.
To non-medical legislators, it seems that Vivitrol works. After all, it prevents those using opioids from feeling any effect. Unfortunately, legislators often don’t understand that our own opioid system is critical for us to be successful in life. By blocking the opioid receptor, we are preventing key human attributes of motivation, confidence, comradery, reward, and teamwork. This makes it very difficult to be successful members of society. 


Vivitrol may have its place in treatment of those who are already highly motivated and have a strong social support system. I have used it to treat some people with OUD. But to say that it is the best treatment and should be used first in everyone will not help our opioid problem. In fact, more will die. 


Alkermes’ efforts to bypass the medical community and market directly to legislators, judges, and law enforcement is a necessary marketing program as they must bypass the expertise of addiction professionals if they want their medication used in significant amounts. These efforts are described in this recent New York Times article. NPR did a story on it as well. 


So why would Alkermes spend so much time and money lobbying legislators? The retail cost for Vivitrol is over $1700 per injection (Goodrx.com, 2017). In my opinion, that is too much to pay for a drug that after 6 months is successful in less than 5% of people in the real world. 

 

References:


Cousins, S. J., Radfar, S. R., Crèvecoeur-MacPhail, D., Ang, A., Darfler, K., & Rawson, R. A. (2016). Predictors of Continued Use of Extended-Released Naltrexone (XR-NTX) for Opioid-Dependence: An Analysis of Heroin and Non-Heroin Opioid Users in Los Angeles County. Journal of Substance Abuse Treatment, 63(April), 66–71. http://doi.org/10.1016/j.jsat.2015.12.004


Goodrx.com. (2017). Vivitrol Prices and Vivitrol Coupons - GoodRx. Retrieved June 15, 2017, from https://www.goodrx.com/vivitrol?drug-name=vivitrol

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