Addiction Treatment Options : Naltrexone (Vivitrol) vs Buprenorphine (Suboxone)

Treatment for opiate dependency leave those seeking it with several options, which can undoubtedly be confusing.  This post is focusing on the differences and effectiveness of two addiction treatment options - Naltrexone and Buprenorphine.

The two drugs are somewhat of opposites in the way they treat dependency to opiates. The average opiate user is dependent to short term acting opiates, which peak in their system within minutes to at most a few hours.

Let's go over each option, including pros and cons

NALTREXONE

Naltrexone is opiate antagonist used to simply block the opiate receptors that are stimulated by the user's usual opiate of choice.  This means they are unable to gain any high from opiate's because the naltrexone is blocking the receptor.  Before starting treatment using naltrexone it is suggested to clear your body from opiates.  The drug is administered by monthly shot (vivitrol) or daily pill form.  A time frame for staying on naltrexone varies.  One key issue about naltrexone is that once treatment is stopped and the chemical has left your body, the opioid receptors are highly sensitive to opiate/opioid activity.  As with any drug, your body develops a tolerance to it resulting in receptors super sensitized for a time period after naltrexone use stops.  Any opiate activity is multiplied because of this, which leads to a much lower threshold for an overdose.

Other points of note with naltrexone treatment

-Vivitrol treatment costs approximately $1000/month if not covered by insurance

-Patients must cease use of opiates for a week or two before beginning treatment (effectively detoxing)

-Beginning treatment will most likely lead to withdrawal syndrome if you do not detox 100% (all the opiates on receptors are ripped away by administered naltrexone)

-No consequences if treatment is stopped, therefore patients likely to relapse more often knowing they can stop daily naltrexone pills and use opiates ( or can use opiates during last days of vivitrol cycle)

-Naltrexone does not relieve cravings

-Naltrexone is likely blocking body's natural endogenous opioids (endorphins)

-Leads to supersensitive receptors when treatment stops - multiplying dangers of relapsing 

Read about increased mortality for Naltrexone Patients in Austrailia 
 Naltrexone Deaths Austrailia








BUPRENORPHINE

Buprenorphine is a partial agonist opioid used to fill the opiate receptors in the body.  Buprenorphine is unique in that is stimulates the receptors as an partial opiate agonist, leading to a reaction similar to that of full agonist opioids.  This replaces the patients opiate of choice. Buprenorphine essentially takes the place of the previously used opiate, but also provides a blockade effect because of the drugs extremely high receptor affinity. The drug also has a very long half-life, so once a day dosing is sufficient to maintain a steady level in the bloodstream. Basically, buprenorphine treatment allows the patient to experience little withdrawal symptoms by replacing the drug of choice, and also stops any other opiate/opioid activity on the body's receptors.  The downside is that the patient's body is still dependent on an partial agonist opioid. 

Other points of note with buprenorphine treatment

-Buprenorphine/Suboxone treatment can cost anywhere from $100-$500/month if not covered by insurance

-Patients can begin buprenorphine treatment usually within 24-72 hours after last opiate used

-Patients face the consequences of detoxing from buprenorphine if they intend to get high from opiates 

-Buprenorphine relieves cravings by replacing full agonist opiates with the partial agonist opioid 

CONCLUSION

Naltrexone seems a promising course of treatment for opioid dependency, but some aspects of the treatment are very risky.  The fact that when naltrexone treatment is stopped, the body is super sensitive to opiates, unfortunately may be highly appealing to an opiate addict.  Knowing that a dose of opiates would gain them euphoria like never before, is not a great thought to have in mind when just recently having ceased treatment for addiction.  Whats more, this not only can be harmful for recovery, this has been shown to cause overdose deaths in high numbers.

If a patient has the will to detox their body from opiates for 2 weeks, then they may be better off completely free from any type of medication.

Buprenorphine is an attractive treatment option, but still means being dependent on a partial agonist opioid.  Many patients have been successful with buprenorphine because it allows them to get their life back in order, and form a foundation to build upon in their future.

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Take Care