Vivitrol Vs. Suboxone: Opioid Addiction Meds Go Head-To-Head In Study

By Kelly Burch 11/17/17

Both medications were associated with a high rate of relapse, but more people in the Vivitrol group dropped out of the study before even starting treatment.

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A new study examined the efficacy of Vivitrol and Suboxone, two of the most commonly used medications to treat opioid addiction.

The study, published in The Lancet and funded by the federal government, followed 570 people with opioid use disorder over 24 weeks. The study found that 52% of people treated with Vivitrol relapsed during that time, compared with 56% of people treated with Suboxone, according to a New York Times analysis

The two medications were found to be nearly equally effective, although there were high rates of relapse for both in the study.

“The main finding in my view is the relatively equivalent safety and effectiveness of these two medications,” said Dr. John Rotrosen, a psychiatry professor at New York University School of Medicine and the study’s lead investigator.

However, the study did highlight key differences between the medications. Suboxone, which contains a mild opioid and naloxone, and is taken daily, can be started soon after opioid withdrawal symptoms begin and help alleviate those symptoms. Vivitrol, a monthly shot that blocks the opioid receptors and does not contain any opioids, cannot be given until withdrawal is complete. 

Because of this, more than 25% of people assigned to be treated with Vivitrol dropped out of the study (and many relapsed) before starting the medication, study authors found. Only 6% of participants who were treated with Suboxone dropped out before receiving their first dose. 

In an editorial that accompanied the study, David Lott, a professor at the University of Illinois College of Medicine, noted that it was concerning that so many people relapsed while waiting to start Vivitrol. 

The makers of Vivitrol have aggressively marketed the drug as a better alternative over other medication-assisted treatment (MAT) drugs like Suboxone and methadone, spending $19 million on lobbying since 2010. Many people who are skeptical of MAT like the fact that Vivitrol does not contain an opioid, and thus does not “replace one addiction with another.”

Because Vivitrol does not have any mood-altering properties, it is not sold on the black market or abused, which makes it popular in drug courts and prison systems. However, the drug is about three times more expensive than Suboxone, costing $1,000 per shot for private insurers and $500 per shot for Medicaid. 

Suboxone remains the most common medication used in MAT, but it does have its own problems—for one, it's not easy to obtain. Makers of the drug have been sued by 43 state attorneys general for blocking generic competition of the drug, says the Times

Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), said in another accompanying editorial that the study shows that both drugs have benefits, and that doctors need to weigh what is best for their patients. 

“It’s extremely important,” said Volkow. “What patient characteristics can lead me as a physician to determine that this particular individual will do better on one of these medications than the other? We have it for every other area of medicine, but not for the treatment of opioid use disorders.”

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.