Talking Points Fact Sheet Members of our YRS group are especially interesting in promoting the use of naltrexone (oral, injectable) because of its medication properties mentioned below. It is a much underutilized treatment option for many different reasons. The Amador Health Center is making naltrexone a key part of its Recovery Project. New Mexico has been the top state in alcohol-related deaths since 1997; this statistic covers death related to both chronic diseases like cirrhosis and injuries such as vehicular accidents involving alcohol. Approximately only 10% of persons with alcohol use disorders (AUD) enter recovery treatment, with only a small percentage receiving medication assisted treatment with FDA approved drugs.
Naltrexone (NLTX) is a non-narcotic opioid blocker. When stopped, it does not cause withdrawal symptoms. Naltrexone is a FDA-approved medication assisted treatment (MAT) for both opioid use disorders (OUDs) and alcohol use disorders (AUDs). Oral naltrexone was approved for heroin dependency treatment in 1984 and for alcohol abuse treatment in 1994. Injectable naltrexone was approved as an anti-addiction medication in 2006 for alcohol and in 2010 for opioids. It comes in a generic tablet (ReVia) and a monthly injectable form (Vivitrol) from Alkermes. It is most effective when combined with counseling and social support services.
The retail pharmacy price for a month’s supply of tablets is less than $50 while the injection may be $1000-1200. It is on the NM Medicaid (Centennial Care) formulary. The patient must be opioid free for at least 7 days before medication administration; with buprenorphine for 10 days and with methadone for 14 days. Vivitrol may be administered to someone who has been drinking heavily if not in alcohol-related withdrawal; there is no required abstinence for alcohol but its efficacy improves if one is not drinking when starting treatment. Vivitrol is contraindicated for someone who is pregnant/breastfeeding, may need opioids for chronic or acute pain management, or has severe liver or kidney damage. The FDA has reported certain side effects associated with Vivitrol use. The most common adverse events were hepatic enzyme abnormalities, injection site pain, insomnia, and decreased appetite; most side-effects are minor and temporary. Oral naltrexone should be discontinued 48-72 hours before surgical procedures that may require opioid analgesics. The duration of action of injectable naltrexone after 30 days is less certain before surgical procedure. Vivitrol injection eliminates the possibility of drug diversion and patient non-compliance. If patient uses heroin or prescription painkillers while on Vivitrol, he/she does not get “high”; it blocks the euphoria effect so a person is less likely to continue drug misuse. If a patient uses alcohol while on Vivitrol, the “buzz” effect is minimized but someone can still experience different degrees of sedation impairment with coordination and judgment (i.e., driving under influence). The Sinclair Method of harm reduction moderation by taking oral naltrexone 1-2 hours before choosing to consume alcohol beverages shows that the medication reduces number of drinking days and the number of drinks consumed for most persons with this approach. The use of Vivitrol in criminal justice populations has been widely studied and reported in peer-reviewed journals, with substantial evidence that it an effective relapse prevention treatment modality at least equal to methadone and buprenorphine for recovery:
It increases patient retention in addiction treatment programs.
It decreases rate of relapse for persons in substance use disorder (SUD) recovery.
It lowers the rate of drug-related criminal activity.
It reduces the rate of drug-related disease transmission.
It reduces ER visits and hospital admissions related to drug use.
Vivitrol is used extensively in jails and prisons in many states as a medical component in ex-offender community reentry programs. Naltrexone "off label"is used as a medication for methamphetamine use/misuse.