Use of Vivitrol for Alcohol and Opioid Addiction

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1 Use of Vivitrol for Alcohol and Opioid Addiction Ken Bachrach, Ph.D. Clinical Director, Tarzana Treatment Centers, Inc.

2 What is Vivitrol? An injectable from of naltrexone, which as a pill was FDA approved in 1984 Reduces cravings or the urge to drink alcohol Blocks the effects of opiates and also reduces cravings to use opiates Compliance not a major issue, since it lasts 30 days

3 Extended-Release Injectable Naltrexone (Vivitrol) FDA approval for alcohol 2006 FDA approval for opiates mg intramuscular injection once every 30 days Must be refrigerated Needs to be at room temperature at time of injection Opioid antagonist should be opioid free for at least 7 days

4 Extended-Release Injectable Naltrexone (Vivitrol) Vivitrol represents an improvement in the technology delivery system, which was developed by Alkermes Naltrexone is infused into polymers, which are widely used in medicine (e.g., absorbable sutures) These polymer microspheres slowly release the naltrexone over 30 days It is administered via a gluteal IM injection, alternating buttocks each injection Must not be administered intravenously or subcutaneously

5 Opiates Bind to the Mu Receptor in Agonist the Brain Binds to the receptor and produces strong euphoric effects (e.g., heroin) Partial Agonist Binds to the receptor with weaker euphoric effects (e.g., buprenorphine) Antagonists Binds to the receptor with no opioid effects (e.g., naloxone)

6 Partial vs. Full Opiate Mu Agonist death Opiate Effect Full Agonist (e.g., methadone) ceiling effect Partial Agonist (e.g., buprenorphine) Dose of Opiate Antagonist ( Vivitrol)

7 Vivitrol Carton Supplies

8 Common Concerns about Vivitrol Vivitrol IS NOT ADDICTIVE There is no pleasure or euphoria from taking Vivitrol One cannot become dependent on Vivitrol There is no withdrawal when one stops taking Vivitrol Vivitrol does not block a person s ability to experience pleasure through everyday activities

9 Side effects The most common side effects are: Injection site reaction 69% Nausea 33% Headache 22% Fatigue 20% Side effects usually peak by day 3 after the injection and then subside Side effects usually decline with each subsequent injection The number of people who stop taking Vivitrol due to side effects is very small

10 Who should take Vivitrol? A person who is dependent on alcohol or opiates; and Who reports significant cravings to use alcohol or opiates as measured by a score of 10 or above on the Urge to Drink Scale

11 URGE TO DRINK SCALE 5 items INSTRUCTIONS: The following questions are designed to help you assess an important aspect of your recovery status: the urge to drink. Complete this form by thinking about the past week and placing a check mark next to the response that is most true for you. 1. How often have you thought about drinking or about how good a drink would make you feel during this period? Never, that is, 0 times during this period of time.(0) Rarely, that is, 1 to 2 times during this period of time.(1) Occasionally, that is, 3 to 4 times during this period of time.(2) Sometimes, that is, 5 to 10 times during this period or 1 to 2 times a day.(3) Often, that is, 11 to 20 times during this period or 2 to 3 times a day.(4) Most of the time, that is, 20 to 40 times during this period or 3 to 6 times a day.(5) Nearly all of the time, that is, more than 40 times during this period or more than 6 times a day.(6) SCORES OF 10 OR HIGHER ASSOCIATED WITH INCREASED RISK FOR RELAPSE.

12 Urge to Drink Scale Items At its most severe point, how strong was your urge to drink? 3. How much time have you spent thinking about drinking or about how good a drink would make you feel during this period? 4. How difficult would it have been to resist taking a drink during this period of time if you had know a bottle was in your house? 5. Keeping in mind your responses to the previous questions, please rate your overall average alcohol urge to drink for the state period of time.

13 Reasons to Use Vivitrol Significantly reduces cravings to use alcohol for most patients Decreases the likelihood of relapse Allows the patient to focus more on their recovery rather than just managing cravings Gives patients more choices and new options

14 Continuation / Discontinuation There is not an established time frame for how long one should stay on Vivitrol Since we know that relapse is most likely during the first 90 days in treatment, patients should stay on Vivitrol at least three months, if they are benefitting from the medication Some individuals may benefit from being on Vivitrol for up to one year or longer, especially if they have strong cravings to use and a long history of addiction

15 Cost of Vivitrol Expensive Medication Cost can be $500-$550 (through 340B) and up for a 30 day dose retail price $ Must be obtained from specialty pharmacies Addition costs to pay medical provider for injection Insurance companies are now starting to cover Vivitrol since they are realizing that it may actually save them money for subsequent treatment costs Medicaid is paying in California for Vivitrol

16 TTC s Experience with Vivitrol First injection given Have had over 1000 patients on Vivitrol We are one of the leading prescribers of Vivitrol nationally In 2013 we administered 676 Vivitrol injections to 330 patients

17 UCLA Evaluation Findings of LA Country Pilot Project Treatment adherence (at least 2 doses) was almost 70%, similar to what was found with other studies and higher than noted with oral naltrexone Engagement in treatment (LOS at least 30 days) is higher for patients who took at least one dose of Vivitrol compared to other patients admitted for primary alcohol use

18 UCLA Evaluation Findings of LA Country Pilot Project Patients reported significant decrease in alcohol use reducing their prior month s use from 17 days to less than 2 days Over the course of 8 weeks, cravings for alcohol were reduced from an average score of 15.7 on the Urge to Drink scale to 7.3 Less than 10% of patients reported any side effects or few left treatment because of the side effects

19 Patient Interview