DECATUR — Local addiction specialists say their experiences correspond to the results of a new national study that compares two drugs used for opioid addiction treatment.
The study, published Tuesday in the journal The Lancet, found that a monthly shot of naltrexone (Vivitrol) prevents relapses as well as a daily dose of the drug buprenorphine (Suboxone).
"Vivitrol can be just as effective as Suboxone if you can get people to go through multiple days of detox first," said Dana Ray, chief medical officer for Crossing Healthcare. "But it's not necessarily an option for everyone."
Many addiction treatment programs don’t offer either medication, or only one of them. However, those drugs, along with methadone, are the three opioid treatment options currently available in Decatur.
Crossing and Heritage Behavioral Health Center jointly operate an outpatient opioid addiction clinic, which opened at 1029 N. Water St. in 2016. There, Suboxone and Vivitrol treatments are provided to patients, while Heritage continues to operate a methadone clinic that opened in 1993.
Amy Morgason, Heritage's director of substance abuse and court services, said patients are treated with methadone, Vivitrol or Suboxone, based on their needs. While they work differently, each drug blocks the powerful highs created by addictive opioids.
Vivitrol requires a patient to fully detox first because, if taken too soon, it can cause severe and sudden withdrawal symptoms. Suboxone can be started sooner, while patients still have mild withdrawal symptoms.
For some, Morgason said, staying away from opioids is easier said than done.
"It's hard," Morgason said. "I've never seen anything like it. Opioids are just so different."
Recently, President Donald Trump declared the opioid crisis a national public health emergency. Overdoses, most involving prescription painkillers and other opioids, killed 64,000 people in the United States last year.
Ray said withdrawals are one of the biggest stumbling points for patients who are treating their addictions with Vivitrol. Crossing provides the drug to many of its patients, she said, and it works well for those who complete the detox before taking it.
The new study recruited users of heroin and pain pills from eight detox centers across the United States.
Half of its participants were assigned monthly shots of Vivitrol, which contains extended-release naltrexone. The others got daily Suboxone, a buprenorphine-naloxone combo in a film that dissolves under the tongue.
After six months of outpatient treatment, including voluntary counseling, 65 percent of the Vivitrol group had relapsed compared to 57 percent of the Suboxone group.
Anyone who dropped out of the study was scored as having relapsed.
The difference in the groups stemmed almost entirely from patients who left during detox for Vivitrol. Twenty-eight percent dropped out before getting Vivitrol, compared to 6 percent who dropped out before a first dose of Suboxone.
Of those who actually started treatment, about half of both groups relapsed.
The researchers found no real difference in overdoses. There were five fatal overdoses, two in the Vivitrol group and three in the Suboxone group. There were 23 nonfatal overdoses, 16 in the Vivitrol group — half of those in the dropouts who never received Vivitrol — and seven in the Suboxone group.
Those preferring Suboxone compare it to insulin for diabetes, but others see it as a crutch because it contains an opioid that has a mild effect on pain and mood. Suboxone costs about $100 a month. Vivitrol costs about $1,000 a month.
Methadone was not part of the study. In the U.S., methadone must be given at special clinics. Any doctor can prescribe Vivitrol. Prescribers need special training and a waiver to prescribe Suboxone.
Vivitrol offers “a tremendous advantage” to rural patients who live far from the nearest methadone clinic or trained prescriber, said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which sponsored the study.
“This study removes a barrier, the belief that (Vivitrol) was not as good a medication,” she said.
However, to remain sober, Ray said it takes more than just simply taking a medication. To her, the skills that people learn in group and individual counseling sessions are essential.
Morgason agrees. "People think (Vivitrol) is a magical drug," she said. "It's really an assisting tool to continue sobriety."