Bad news for naltrexone:
Compared to placebo, or to no medication or alternative medications, prescribing oral naltrexone led to no statistically significant differences in the primary retention/abstinence outcomes. The main problem associated with oral naltrexone was high treatment drop-out – across the 13 included studies, 72% of patients did not complete treatment. Newer implant and depot preparations which patients cannot simply stop taking are intended to overcome this problem, but a parallel Cochrane review of these preparations found insufficient evidence to evaluate their effectiveness.
However, this isn’t stopping the forward motion of its marketing:
“It’s a medication that’s gaining a lot of momentum.
The article highlights some of the challenges with pharmacological approaches:
“My patients say that every time they hold that tablet in their hand, they get a craving–they know if they don’t take it that day, they can get high. You don’t totally remove that feeling with Vivitrol, but at least you’re pushing it down the road for a month.”
He tells patients that if they choose buprenorphine, they may be on it for years and it’s not that easy to get off it.
Vivitrol should be used along with some type of counseling, Dr. Kleber says. “If you don’t use counseling, it can be difficult to get a person to come back for the next shot,” he says. “Vivitrol promotes abstinence, but that is not the same as recovery.”
…some adults with opioid dependence prefer buprenorphine because they enjoy feeling some opioid effect…
It also identifies future directions for these pharmacological treatments:
“If we could treat people who were addicted to opiates just prior to release from prison with Vivitrol…
Because the methadone delivery system isn’t “youth friendly,” Dr. Fishman says young people with opioid dependence should be offered either buprenorphine or extended-release naltrexone.
It also challenges the notion that pharmacology is the unfairly excluded treatment option by characterizing it as the “standard of care”:
…daily methadone or buprenorphine, which has been the standard of care for addiction to heroin or prescription pain medications.
Of course, it doesn’t help to bolster our confidence when the government funds studies that systematically misrepresent the effectiveness of drugs.