Scientists study effectiveness of opioid treatments

In an era where drug overdose deaths are the leading cause of injury and death in the United States, the abuse and misuse of opioids is a growing, alarming public health issue — namely, the “opioid crisis”. According to the United States Health and Human Services, 12.5 million people misused prescription opioids in 2015 alone, 2.1 million of those being first-time offenders. Clearly, this is a dangerous social problem that doesn’t seem easy to prevent. The government has been trying to tackle this issue since the late 1990s, but there are few solutions with much scientific proof or potential.

Suboxone, a relatively mild opioid containing a combination of buprenorphine hydrochloride and naloxone hydrochloride, was approved by the United States Food and Drug Administration (FDA) as an effective treatment of opioid addiction in 2002. Patients undergoing treatment take daily doses of Suboxone either in the form of strips that dissolve on the tongue or tablets to minimize withdrawal symptoms. Although much more expensive, this is preferred to another addiction medication known as methadone because it can be prescribed by primary doctors, and does not require specially licensed clinics.

Vivitrol is a relatively new form of addiction medication approved by the FDA only in 2010. This injection of nalextrone that blocks the effects of opioids is to be taken once a month, as its effects last slightly over 28 days. According to Alkermes, it is by far the most expensive opioid addiction treatment substance, costing $500 per shot through Medicaid and $1000 through private insurance. Despite its high cost, Vivitrol has been supported and encouraged by Alkermes as an alternative for Suboxone, as many people view Suboxone as simply substituting a deadly opioid (heroin) with another addictive but less dangerous opioid (Suboxone itself.)

A study comparing these two forms of addiction treatment medication was published in The Lancet on Tuesday. Led by Dr. Joshua D. Lee of the New York University School of Medicine, this was the largest study so far to directly compare the effectiveness Vivitrol with that of Suboxone.

The study was conducted with 570 adults, most addicted to heroin, and found that 52 percent of those who were under Vivitrol relapsed throughout the span of the 24-week study. This is a number only slightly lower than the 56 percent of patients that relapsed under Suboxone in the same study.

While discovering the potential of Vivitrol to become a more widespread form of treatment for opioid addicts in the nation, the study also revealed a fatal flaw of Vivitrol. This not only makes the results of the study much more difficult to interpret but also speaks to the limitations of Vivitrol itself as a treatment substance. A large number of participants were not even able to start treatment with Vivitrol because a detox period (complete abstention from drug use) of three days to one week is required for its consumption. According to Stat News, patients failed to start on Vivitrol at four times the rate that they did Suboxone because of this difficult barrier to beginning treatment.

“It’s going to take a few days or a week or more to get them on naltrexone in the first place,” said Dr. Lee. “And that detox hurdle does not exist for buprenorphine or Suboxone.” However, the research still does encourage medical professionals and treatment providers to offer both medications, as relapse rates are significantly higher if patients don’t get onto and continue a medication.

The bottom line is that both forms of medication should be widely available and readily offered to patients suffering opioid addiction. Now that the effectiveness and safety precautions of both Suboxone and Vivitrol have been studied in depth and published, we have taken a step forward to treat this huge public health issue. Perhaps it was because of the lack of such evidence and research in the past that led to severe under-treatment of the opioid epidemic.