Medication-Assisted Treatment: Vivitrol l The Partnership

Medication-Assisted Treatment: Vivitrol l The Partnership

When we talk about medication-assisted
treatment or “MAT” we refer to an approach to treat patients with substance use
disorder where medication play a major role and there are two main approaches.
One is the agonist approach which includes medication like buprenorphine
or methadone. The other is antagonist approach with medication like naltrexone,
otherwise known as Vivitrol. Vivitrol is a depot form where you inject the
medication into someone’s buttock in the muscle area and what it does is it
basically is dispensed throughout your body over time so it stays in your system for
a little over three weeks to a month. It binds to the opiate receptor and blocks
it. You can’t get the [sic], the feeling of getting high and that is so much more
powerful than I think we ever knew. Growing up…I grew up with a father and mother, two older brothers. There was no divorce, no broken home, nothing like that. I kinda
had a very good group of role models growing up, but I wasn’t ever gonna be
the student my oldest brother was and I tried my hardest, but I could never be
the athlete my middle brother was so I found my niche if you will by being
popular and partying you know having fun so when I first tried drugs and alcohol
you know it was another way for me to stand out from the crowd. And I knew
there was senior year and the kids liked to party, but I never thought it would
get into anything heavier than just a beer. When I got to college was really
where things kind of went downhill for me. I had gotten a lacrosse injury. I
broken a bone in my foot and the doctor I went to prescribe me Oxycontin 20
milligrams. I knew thinking to myself “this is bad.”
Nothing should feel this good. You know if something feels this good and takes
away this much pain, like it shouldn’t be in the possession of you know a 20-year
old. I was hooked right away. It didn’t take long for me to become an everyday
addict. It was a horrible life you know. It’s lonely. It’s depressing. I had a
really bad stretch, -two close friends of mine passed away from suicide. One was
from drugs. That’s when I kind of derailed. I wanted to end everything, so I
was up on the top of my apartment building and I just couldn’t
bring myself to jump. He had a terrible freshman year academically [mother: yeah] at school. I had a notification from the school that he was on basically
probation. Joanne and I talked separately. She called them and I think she called
me and said you need to go get him. And I was clean for about two or three
months off everything. I went to hang out with some friends one night that summer.
Someone mentioned painkillers and it was like I let the gorilla out of its cage
again. You know, I was back on them and I was back on them worse. Society we all
think why can’t these people these patients, these addicts, just stop and
it’s not like that. They’re not the same person once they become dependent on
drugs. They’re a different person. They can’t get to those same skills that they
once could get to because their brain is now rewired. It’s only thinking about the
drug. I’d been wanting to get off the substances for so long. I just hated myself. I didn’t want to be this person anymore. Mike initially convinced us that, you
know, he’d seen a light, he wanted this to end. He had been trying to do it on his
own, but never was able to get more than a couple of days or maybe a week without
using and he’d always find his way back to it. Most patients were using daily prescription opioids or heroin. They
have to use those substances every day, because if they missed a dose, if they
don’t use it for 12 hours, they start developing very uncomfortable withdrawal symptoms. It’s painful to go through withdrawal, especially if you’ve been on an opioid for a really long time. Withdrawal from opiates is the single worst
experience anybody could have to go through. Once we realized that we had a
much more serious problem on our hands, we knew it couldn’t be handled on an
outpatient basis. He was first prescribed suboxone, which he did try and it just
wasn’t effective, cause like I said [yeah] he could choose not to take it. Vivitrol is very different in terms of who might benefit from vivitrol versus who
might benefit from methadone and who might benefit from suboxone or
buprenorphine. A patient who has, you know, strong family support, who’s highly
motivated for treatment, who is aware of, you know, what the risks are in terms of,
you know, the side effects and, you know, what their what they’re actually what
their treatment goal is. It’s very important too. If the patient is, you know,
hoping to have a lifelong plan of abstinence, then Vivitrol is a great
choice. The attraction of Vivitrol was it was an injection that was both a
positive and a negative and once injected, you couldn’t avoid it. It was in
your system. The bad news was if you if you fell off the wagon, you’re liable to do
something really dumb. There are dangers associated with Vivitrol. If a patient,
you know, is on Vivitrol for a period of time and then they stop Vivitrol or
they miss a dose, their tolerance now has dropped significantly and if they were
to now use opioids in the same way that they used in the past, they could
potentially overdose. Vivitrol can cause depression in some patients and
you do really want to watch them closely and make sure that, you know, that the
depression doesn’t get exacerbated or the Vivitrol is not exacerbating that
depression, so that is something we always make sure to discuss at length
with both the patient and, you know, significant other, or family member to make sure that they’re aware of this. It is necessary for patients to abstain from
opiates before they can get started with naltrexone. It’s a trying time for the
patient and for the doctor, but it can be, with the help of medications you know,
many patients are able to go through this process. Most of the time they do it
at the inpatient setting in the hospital, but it can also be done in outpatient
setting with daily visit to the doctor’s office for evaluation and additional
medications to take at home. Typically when a patient’s on Vivitrol, I like to
have them stay on the shot for at least six months. I have patients that have
been on it for two years and they just don’t want to come off of it because
they find it so effective and the quote unquote insurance policy is just so
valuable and warranted for their functioning that, you know, why would they go off. People get on this shot and then they can function. In their own mind,
they’re not an addict anymore. That’s so valuable. That’s so amazing because now
they can go to work, they can live their life, they can be in the relationships
that they’re in in a different way. It’s important to remember that those
medications are most effective when they’re used in conjunction
with counseling, therapy, recovery work, self-help groups, many other ways that we know are very helpful for people who are trying to abstain from substances.
Counseling, this is important for so many reasons. Usually the first month is
difficult and then it just gets easier with time and that’s why it is so
important to have, you know, support systems like NA, like groups, like IOP,
which is an intensive outpatient program, or outpatient programs in general, or a
psychiatrist, or a therapist, or a social worker to somebody that actually can see
them weekly and kind of check in with them see how they’re doing, make sure, you know, that they’re feeling okay, make sure that they’re cravings are under wrap, making sure that they’re they’re functioning. It’s more than fair
to say that Vivitrol helped me throughout my recovery. It was more of a
safety blanket. You know it’s a huge exhale knowing, like even if I tried
something [I’m] not getting high. Doesn’t matter so why even bother. Old-timer AA’s
may still say that, you know, you’re not really in recovery if you’re on
something and that this isn’t real recovery because you’re taking something, “you have a crutch,” but that’s really, I think we’re kind of steering away from
that. SMART recovery is kind of where we’re now entering, where we’ll do
anything that’s going to help us get to a place where we’re in recovery right. So
anything that’s going to work is the best treatment and we’ve found now that
medication-assisted treatment actually there’s less relapses, there’s higher
levels of functioning, people are in better places emotionally and they’re
not using so why would we not use medication-assisted treatment, especially
statistically when we’re seeing that there’s better outcomes. I look at him.
He’s blossomed. He’s his old self. You know, he’s,
unfortunately he’s lost a lot of friends. People say in recovery once you start it
buy a suit, or if you’re a woman buy a nice dress. You’re going to be at a lot
of funerals. I’ve lost probably twelve really close people and I’m only
twenty-five. The heroin epidemic is, is, gotten outrageous and there’s you know
specials on all over the place where overdoses everywhere. We’re talking more
about you know what’s happening, the story, but not about how to help it.
Seeing how many patients benefit from Vivitrol, from suboxone, it’s, it’s a life
changer. I mean this is why I love this job because people get better.


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