Are There Alternatives to Suboxone?
Updated: Dec 4, 2018
People often overlook or dismiss the lesser known alternatives to Suboxone that also help treat opioid use disorder. While it is true that Suboxone is the mainstay of treatment at most office-based opioid treatment (OBOT) programs such as ours, most should offer at least one other popular alternative known as Vivitrol. Vivitrol is the tradename for the drug Naltrexone which is similar to Naloxone (Narcan) in that it is a pure opioid antagonist so it will displace any opioid in your body, attach to the pain receptor, and completely block it from activating. The benefit in this is that while on this medication even if you were to use any pain pill or heroin it would have absolutely no effect. It also helps to control cravings although to a lesser degree than partial opioid agonists such as Buprenorphine. Vivitrol only comes as a 30 day intramuscular injection which can only be administered in a doctor's office although there is another form of Naltrexone that comes as a tablet called Revia although this is not recommended as a long-term viable treatment option due to concerns about compliance issues.
The Pros and Cons of Vivitrol
We are big proponents of Vivitrol and recommend it at every opportunity we can. However, it is not for everyone and there are definitely some major obstacles that one can run into if interested in this treatment. First of all, because Vivitrol is a complete opioid blocker you need to be completely off all opioids for at least a couple days before getting started on this or else you will be thrown into acute withdrawal. This even applies to Suboxone so for those wanting to wean off Suboxone and then transition to Vivitrol you would still need to wait at least 7 days due to the long acting nature of Suboxone. The same applies for methadone which is another long acting opioid that tends to linger in your system long after you stop taking it. Typically for heroin and other shorter acting opioids such as Vicodin or Percocet you would only need to wait a few days before getting started on Vivitrol although most individuals have trouble making it through the withdrawal period in order to get to the correct state. Another issue with Vivitrol is that is can be rather expensive without insurance. The medication alone costs around $1200-1900 and that doesn't include the cost of administration. Luckily there are coupons and other assistance programs available to bring the cost down. Also, Indiana Medicaid (Healthy Indiana Plan) completely pays for the medication which is a huge plus.
What Else Is There
Buprenorphine and Vivitrol are just two of the FDA-approved medications used to help treat opioid use disorder. These drugs are known as medically-assisted treatment (MAT) and have become the gold standard in the fight against opioid addiction. There is also one other FDA-approved MAT medication called methadone which is actually the oldest and most well known of these drugs. Methadone differs in several ways but one of the main differences is that it can typically only be dispensed at Opioid Treatment Programs (OTPs) which are much more highly regulated which is why fewer of these exist. You typically have to go on a daily basis at first to receive your medication and methadone is like any other opioid in that it is a full opioid agonist and comes with all the negative side effects such as sedation and respiratory depression. It is also easier to abuse other opioids while on methadone and some patients even view methadone as their drug of choice. For these reasons, I am not a huge fan of methadone but it does have its place in society and has worked well for many individuals over a long period of time.