Should I Use Extended-Release Naltrexone?

depressionExtended release Naltrexone (Vivitrol), made by Alkermes pharmaceutical company, blocks your dopamine and hence the pleasurable effects of alcohol or opiates, for a month from a single $1000 shot. Sounds like a wonderful thing right?  Think again.

Realize that when you block dopamine you are blocking the ability to feel OK, to feel good.  The very thing that everyone needs to climb out of a depression or addiction is dopamine.  Why would you want to block it?

As an addictionologist, I have attended the pharmaceutical sponsored dinner at the national Addiction scientific conference.  During this wonderful free meal, we were “educated” on the benefits and promising future of IM Naltrexone (Vivitrol) for use with alcohol and opioid dependent patients.  You see, this drug takes away the pleasure you might get from alcohol or opiates, so you theoretically would just stop drinking or using opiates.  In the study “Extended-release medication offers promise for treating alcohol, opioid dependence” at Oregon State (you can read that here…) they do a cost analysis to show that despite the huge cost of the medication – this treatment will save money by preventing hospitalizations!

When I shared my one and only personal experience with this drug- a single shot given to an alcoholic in his mid 20’s  who was triggered into an immediate suicidal, most severe depression, anxiety, and depersonalization episode that lasted well over a year, the company stopped contacting me or trying to get me to use the drug.  You see as physicians, when we have an adverse drug reaction we are told to notify the company that makes the drug!  That did nothing to get this dangerous drug off the market.

The package insert includes the warning 1-5% chance of depression or death.  Well, which is it 1 or 5%?  Even still, if you knew you had a 1% or 5% chance of killing your patient, would you use that drug?  The industry response I got to those questions was that you must compare that to the much greater chance the patients would commit suicide if untreated.  Well in my 5 years of treating opiate addicts (they are at the highest risk of suicide and death) I have not had one suicide out of the hundreds of patients I have seen.  It seems not using Vivitrol is safer than using it.

This is on medication I would simply say no to.   Very few patients who take this once will return for more unless there is a huge coercion factor.

Having almost killed the one patient I tried this medicine on, that is 100% risk of severe side effects!  Of course one does not make for good research, but just plain good old common sense would tell you that blocking your ability to feel good, to feel pleasure, to think normally, would just not be a good choice.

 

 

Dr. Paul

 

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