Vivitrol or Suboxone? That is the Question

By Zachary Siegel 06/04/15

Controversy surrounds a new medication-assisted treatment program targeting people in the criminal justice system.

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There is much contention surrounding a new opiate addiction treatment program which would target individuals who are involved in the criminal justice system.

The Department of Health and Human Resources (DHHR) in Charleston, W.V., is in the preliminary stage of implementing the new treatment protocol, which would provide medication-assisted treatment (MAT) to justice-involved opiate addicts. The question becomes, which medication ought to be used, injectable-Vivitrol or Suboxone.

The two camps become those who believe in complete abstinence in favor of Vivitrol pitted against those who see the utility in drugs like Suboxone. Some in the 12-step community do not regard those who take Suboxone as being “clean.”

Dr. Carl Sullivan, director of the addictions program at West Virginia University, told The Charleston Gazette that he leans toward using Suboxone because opiate addiction has the potential to create long-term changes in the brain chemistry, changes that an injection of Vivitrol will not necessarily address.

The Gazette did note that Dr. Sullivan received nearly $3,000 in consulting fees from Reckitt and Benckiser, the company that manufactures Suboxone.

The other camp prefers Vivitrol, as it is has no euphoric effect and therefore has no black market value. Jennifer Bailey, Kanawha County Circuit Judge, said she has already seen the success of recommending Vivitrol to individuals in the criminal justice system.

As it stands, Suboxone has not been approved by the court because of it’s potentially intoxicating effects. “They would sell it,” Judge Bailey told the Gazette. “They would be dishonest about the dosages they were taking, and it’s not an acceptable drug in our [court] program.”

Jason Chenkis, a reporter for the Huffington Post, has written numerous articles exposing the link between rates of overdose in people who have been denied medications like Suboxone through drug courts. He has highlighted how such abstinence-based models contradict medical research and best practices.

Another stab against judges like Jennifer Bailey is why they possess the power to make medical decisions—a field for which they have no training in—when such decisions have been linked to fatal overdoses amidst a country-wide heroin epidemic.

The last problem yet to be figured out in the program is cost. Medicaid bills $550 per every shot of Vivitrol and roughly $400 for Suboxone.

All the controversy and ideology must be cast aside with respect to the goals of the program. Many people with drug addiction are serving time for non-violent offenses which were committed to support their habit. The program aims to reduce recidivism in the drug population and test the efficacy of medication-assisted treatment.

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Zachary Siegel is a freelance journalist specializing in science, health and drug policy. His reporting has also appeared in Slate, The Daily Beast, Salon, Huffington Post, among others. He writes often about addiction, sometimes drawing from his own experience. You can find out more about Zachary on Linkedin or follow him on Twitter.