The United States is experiencing a devastating epidemic of drug usage and overdose deaths. According to the Centers for Disease Control and Prevention, the number of overdose fatalities reached a new high of 47,055 in 2014, or about 125 Americans every day. The dramatic increase in overdose deaths is driven largely by the explosion in addiction to opioids, primarily prescription painkillers and heroin. Since 1999, the number of overdose deaths involving opioids has nearly quadrupled.
“Prescription opioids play an important role in reducing pain and suffering,” says neurologist and addiction medicine specialist Dr. Russell Surasky with Surasky Neurological Center for Addiction, “but opioids as a class of drugs have great potential for misuse and as the number of prescriptions has skyrocketed in the last 25 years, we have seen soaring increases in the negative consequences related to their abuse.”
Addiction is often misunderstood and continues to be seen by many people as a moral failing and a problem than can be overcome by a simple exercise of willpower. In fact, addiction is a complex disease. Drugs change the brain in ways that make it difficult to resist the impulse to continue taking the drugs. Opioids act by attaching to receptors in the brain that are stimulated to reduce the perception of pain and produce a feeling of well-being. When the drug wears off it detaches from the receptors and strong cravings compel taking another dose. After repeated use, opioids induce tolerance, meaning higher and higher doses are needed to achieve the same level of response. Over time, opioids cause long-term changes in the brain that persist even when the drugs are stopped and can cause cravings and relapses years later.
“For an addicted person to simply decide to permanently stop using opioids is next to impossible,” says Dr. Surasky. “After as little as a few weeks of use, opiates ‘hijack’ the brain and the need for the drug becomes overwhelming. Unless the neurological damage can be healed, those cravings will persist for the rest of a person’s life. Fortunately, we have learned a great deal about how these drugs affect the brain and we now have treatments that undo the damage, prevent relapse and help people achieve permanent recovery.” One of the newer and most effective treatments for opioid addiction is naltrexone (brand name Vivitrol®). “Vivitrol is a medication that immediately stops cravings and withdrawal symptoms,” says Dr. Surasky. “With the patient’s firm commitment to recovery, along with counseling and a strong support system, Vivitrol is a powerful tool in treating addiction to opioids and alcohol.”
Understanding how Vivitrol works
Vivitrol is an “opioid antagonist,” meaning it binds to the receptors in the brain and prevents opioids from acting on the receptors. By blocking attachment, Vivitrol prevents the pleasurable opioid effect and reduces cravings for the drug. A patient on Vivitrol who does take opiates does not get high, does not get sick, and does not crave drugs. But a patient who discontinues Vivitrol and resumes opiates no longer has tolerance for the drugs and is at great risk for the dire consequence of an overdose.
What is Vivitrol treatment like?
Vivitrol is an extended-release medication that is injected once a month. Because it can cause withdrawal symptoms if opiates are still in the system, it is important to stop drug use 7 to 14 days before the first injection. There may be some side effects of Vivitrol treatment but they are generally mild and transitory. The length of treatment is individualized for each patient to ensure that the psychological and behavioral aspects of the disease have been adequately addressed and the individual has developed the life skills needed to remain drug free.
Is Vivitrol addictive?
Vivitrol itself is not an opioid, is not addictive and does not cause dependence. “Drug addiction destroys lives and families,” says Dr. Surasky. “Treatment with medication along with ongoing substance-abuse therapy and support offers patients a lifeline. Our patients have had remarkable success with Vivitrol. They tell us that they no longer crave or even think about opiates and they feel they have finally broken the chains of addiction.” Vivitrol® is a registered trademark of Alkermes, Inc.
Russell Surasky, FAAN, ABAM, with Surasky Neurological Center for Addiction, is board certified in both neurology and addiction medicine, is one of the few physicians with this combination of credentials. His primary focus in practice is addiction medicine. Utilizing unique medication protocols individualized to each patient, he provides specialized treatment for opiate, benzodiazepine, and alcohol addiction.