15 Jul Extended-Release Naltrexone Key Tool in Treatment of Alcohol, Opioid Addictions
Naltrexone is an anti-opioid medication that doctors can use to help people in treatment for opioid addiction, as well as people in treatment for alcoholism. One specific formulation of the medication, sold under the brand name Vivitrol, is injected into muscle tissue and stays active in the brain and body for roughly one month. In a study published in the Journal of Substance Abuse Treatment in March 2014, researchers from five U.S. institutions explored the reasons why extended-release naltrexone is an effective treatment. The researchers also examined the relative costs of using this medication.
Alcoholism and Opioid Addiction
Alcoholism and opioid addictions are both the products of long-term chemical and structural changes inside the brain, particularly in an area commonly known as the pleasure center. As a rule, both drinkers and opioid users start down the road to addiction when they repeatedly consume alcohol or opioids; potential underlying reasons for this repeated use include a desire to feel increased levels of pleasure, a desire to reduce or eliminate the effects of physical pain and a desire to offset unpleasant moods or emotional states. Whatever the underlying motivation, the brain can come to depend on the presence of alcohol or opioids if exposed to them often enough. In alcohol users, physical dependence is more or less synonymous with alcoholism. However, some opioid users (typically, people following a legitimate prescription) develop physical dependence without experiencing the dysfunction associated with addiction. In addition to dependence and associated problems with withdrawal, addicted opioid users experience symptoms such as recurring urges to take more opioids and the damaging prioritization of opioid intake in daily life.
Naltrexone and Extended-Release Naltrexone
As an anti-opioid medication, naltrexone achieves its effects by blocking the ability of opioids and certain other substances to reach sites in the brain and body called opioid receptors. Without access to these sites, opioid drugs and medications cannot produce their classic intoxicating effects. For reasons that are not fully clear, blockading of the opioid receptors also reduces the pleasure a person can get from consuming alcohol. In turn, this reduction leads to a diminished craving for alcohol. The main form of naltrexone is a tablet that dissolves rapidly inside the body and produces its anti-opioid effects in a few hours. After its injection into muscle tissue, extended-release naltrexone passes gradually into the bloodstream over a period of about 30 days; this form of the medication produces a sustained anti-opioid impact until the time comes for the next monthly injection. Both forms of the medication work in concert with additional treatments for alcoholism and opioid addiction, rather than on their own.
Effectiveness in Addiction Treatment
In the study in the Journal of Substance Abuse Treatment, researchers from Oregon State University, Oregon Health & Science University and three other institutions re-analyzed the results of five previous studies that examined the effectiveness of extended-release naltrexone as a treatment for alcoholism and opioid addiction. All told, these studies included almost 60,000 patients; 1,565 of these individuals received extended-release naltrexone for six months, while the remainder received other treatments for the same amount of time. The researchers conducted their analysis, in part, because of known problems that recovering alcoholics and opioid addicts can have with consistently taking short-acting oral medications.
The researchers concluded that, compared to the study participants receiving the oral form of naltrexone or another oral alcoholism medication called acamprosate, the participants receiving extended-release naltrexone experienced improved results from their treatment. They also concluded that the particular usefulness of extended-release naltrexone is not linked to the specific effects of the medication inside the brain and body; instead, it comes from the increased likelihood that any given person in a treatment program will take the medication consistently.
In addition to assessing the usefulness of extended-release naltrexone as a component of alcoholism treatment or opioid addiction treatment, the researchers assessed the overall cost of using the medication. They chose to investigate this aspect of the medication’s use because extended-release naltrexone costs considerably more than a lot of other commonly available treatment options. The researchers concluded that, although initial cost of the medication is steep, the short-term costs can be offset by a reduced need to spend money for additional addiction treatment and/or hospital stays stemming from addiction-related issues.
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