To the Editor:
In the editorial “Using science to battle stigma in addressing the opioid epidemic: opioid agonist therapy saves lives,”
1
Sarah Wakeman astutely emphasizes the current underutilization of medication-assisted treatments for opioid use disorders, despite the striking evidence behind their effectiveness. The editorial, however, focuses solely on agonist therapy, without mention of US Food and Drug Administration (FDA)-approved antagonist therapy (ie, extended-release injection naltrexone [XR-NTX]), available in the United States as VIVITROL.Extended-release injection naltrexone (XR-NTX) is FDA-approved for the prevention of relapse to opioid dependence after detoxification and should be part of a comprehensive management program that includes psychosocial support.
2
Administered in a once-monthly gluteal injection, XR-NTX is not an opioid and has limited abuse potential. In patients with opioid use disorders, XR-NTX increases the number of opioid-free days, improves treatment retention, and reduces subjective opioid cravings.3
Patients should be opioid free for 7-10 days before beginning XR-NTX and advised of risks, such as injection site reactions and reduced tolerance to opioids after stopping treatment.Antagonist therapies represent an effective, underutilized category of medication-assisted treatment. In response to the worsening opioid epidemic, Congress passed the Comprehensive Addiction and Recovery Act of 2016, which improves access to prevention and treatment resources and requires that all office-based opioid addiction treatment providers have the capacity to provide directly or by referral all drugs approved by the FDA for the treatment of opioid use disorders, in addition to requirements for counseling and ancillary services.
4
This patient-centered approach ensures that individuals living with opioid addiction have the opportunity to discuss with their practitioner which FDA-approved medication treatment—including agonist or antagonist therapy—may be right for them.Comprehensive Addiction and Recovery Act of 2016, Pub. L. No. 114-198. Available at: www.congress.gov/114/bills/s524/BILLS-114s524enr.pdf. Accessed August 15, 2016.
References
- Using science to battle stigma in addressing the opioid epidemic: opioid agonist therapy saves lives.Am J Med. 2016; 129: 455-456
- VIVITROL Prescribing Information.Alkermes, Inc, Waltham, Mass2013
- Injectable extended-release naltrexone for opioid dependence: a double-blind, placebo-controlled, multicentre randomised trial.Lancet. 2011; 377: 1506-1513
Comprehensive Addiction and Recovery Act of 2016, Pub. L. No. 114-198. Available at: www.congress.gov/114/bills/s524/BILLS-114s524enr.pdf. Accessed August 15, 2016.
Article info
Footnotes
Funding: None.
Conflict of Interest: BLS and SCA are employees and stockholders of Alkermes, Inc., which manufactures VIVITROL.
Authorship: Both authors have participated in the writing or critical revision of this manuscript and approved the final version of the manuscript before submission to the journal.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Using Science to Battle Stigma in Addressing the Opioid Epidemic: Opioid Agonist Therapy Saves LivesThe American Journal of MedicineVol. 129Issue 5
- PreviewIn 1965, Dole and Nyswander1 published the first study of methadone maintenance treatment for opioid use disorder. On the basis of research conducted at The Rockefeller Institute for Medical Research with Kreek, they described the treatment of 22 individuals with methadone for chronic heroin addiction. In this landmark study, they reported the notable findings of craving relief, blockade of the euphoria of subsequent heroin use, and a Lazarus-like effect on psychosocial functioning, with treated subjects resuming schooling, work, and relationships.
- Full-Text
- Preview
- The ReplyThe American Journal of MedicineVol. 130Issue 3
- PreviewI appreciate the comments by Silverman, MD and Akerman, MD in response to my editorial. They highlight the importance of including opioid antagonist therapy as a treatment option for patients with opioid use disorder.1 I agree that all treatment decisions must be patient centered and that naltrexone should be an available option. There are select patient populations in whom extended-release naltrexone may be considered preferentially, such as younger patients with a shorter duration of use, those with a high likelihood of abstinence, or people wanting to transition off of opioid agonist therapy after successful treatment.
- Full-Text
- Preview
