Could a monthly injection help my son overcome his opioid addiction?

DEAR DOCTOR K:

My son is addicted to painkillers. He has been in and out of treatment programs, but nothing has worked. I recently heard about a monthly injection that can help people overcome addiction. Can you tell me more about this?

DEAR READER:

The problem of addiction to opioid prescription painkillers (and illegal narcotics) is growing worse. I’m sorry it has affected your son. You are correct: There is a relatively new treatment, called Vivitrol, which has helped some people.

The opioid painkillers include drugs such as Vicodin, Percocet and OxyContin. With continued use, a person can develop a physical dependence on these drugs. That means a person experiences withdrawal symptoms if he stops taking the drug. These drugs can also cause a “high.” Both of these effects contribute to addiction.

I spoke to my colleague Wynne Armand about treatment options for opioid addiction. She is a primary care physician at Harvard-affiliated Massachusetts General Hospital.

Detoxification, or “detox” programs, can help a person get through the initial, intense withdrawal symptoms when coming off a drug. However, detox alone is often not enough. Many people will relapse and use again without additional treatment. The additional treatment may include counseling and long-term medications.

There are three FDA-approved, long-term medications for treating opioid addiction: methadone, buprenorphine and naltrexone. The first two are “agonist” drugs: They produce some of the same “high” as opioids and can be addicting. They also can produce dangerous symptoms if a person takes too much. However, they are less likely to do these things than the opioids.

In contrast, naltrexone is an “antagonist.” It binds to opioid receptors but does not activate them. As a result, it blocks the “high” from other opioid drugs. Naltrexone is available as a daily pill; its effect in blocking a high from opioid drugs lasts only a day. Also, obviously, it only works if it is taken, and people often forget to take a pill every single day.

In contrast, Vivitrol is a long-acting form of naltrexone. It is given as a monthly injection, and its effects last a month. Many doctor’s offices and clinics have started to offer Vivitrol injections.

If someone taking Vivitrol relapses and starts to use opioid drugs again, they will not experience the same high. However, there is a danger with Vivitrol: The person seeking the high may try to overcome the blocking effects of Vivitrol. This can lead to a severe overdose and death.

Also, the risk of overdose or death is high in those who stop Vivitrol and reuse opioid drugs, because after the opioid drugs have been blocked for a while, they become more potent when the blocker is removed.

No studies have compared the three long-term treatments with one another. Vivitrol may be more appropriate for people who have had no success with the agonist treatments (methadone and buprenorphine), have a milder addiction, have difficulty taking a daily medicine and are highly motivated to quit. Ask your son’s doctor for his or her advice.