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MEDICATION TREATMENT
Alcohol & Opioid Dependence

Currently, there are three FDA-approved medications to treat opioid and alcohol addiction: Naltrexone, Buprenorphine, and Methadone. These medications, when combined with therapy to treat substance-use disorders have several advantages over treatment without them. While some may see it taking medication to treat substance abuse as a trade, the truth is that these medications can be the first line of defence against tragedies. Medication dedicated to treatment substance abuse promote sobriety, reduce cravings, alleviate post-acute withdrawal symptoms, and pave the path toward sustainable recovery.

Wilmington Mental Health offers treatment for alcohol use disorder and opioid use disorder through Naltrexone and Buprenorphine. Naltrexone is an opioid antagonist that is taken orally to blocks the effects of heroin, morphine, or other opiates in the brain. It also blocks the euphoric feelings of being intoxicated from alcohol. Buprenorphine (Suboxone) is a partial opioid antagonist that can be taken orally in pill or film form for opioid dependence.

As an extended-release form of Naltrexone, Vivitrol is a prescription injectable that can be used on a monthly basis. Southeast Addiction Center offers the administration of Naltrexone and Vivitrol as a Medication-Assisted Treatment (MAT) modality.

Naltrexone (Vivitrol)
Buprenorphine
NALTREXONE
Vivitrol Treatment
We offer medication assisted treatment for alcohol and opioid dependence, combining medication and counseling services and monitoring usage over time as recommended by best-practice models. Vivitrol is an injectable medicine that can help you with alcohol and opioid dependence after you stop drinking alcohol or undergo detoxification. Treatment with Vivitrol makes your relapse prevention plan more effective.
What is Vivitrol?

Vivitrol is a prescription injectable medicine that can help block the effect of opioid, such as heroin or opioid pain medicines, and prevent relapse to opioid or alcohol dependence in adults†. It is administered by deep gluteal injection every four weeks or once a month. Our healthcare providers can help you decide if Vivitrol is right for you. If you are trying to stop drinking or taking opioids, Vivitrol could be the right solution for you.

Vivitrol must be used together with a recovery program such as counseling to be effective and it is required that you stop drinking or using opioids before you start receiving Vivitrol.

† It is not known if VIVITROL is safe and effective in children.

Dosage & Administration
Must be prepared and administered by a healthcare provider.
Must only be administered as a deep intramuscular gluteal injection.
A minimum of 7-10 opioid-free days prior to initiation of Vivitrol is recommended to avoid precipitation of opioid withdrawal.
The recommended dose of Vivitrol is 380mg
Important Facts
Peak naltrexone plasma concentration ~ 2 hours after injection. Second peak ~ 2-3 days later.
Concentration slowly declines ~ 14 days after dosing.
Total naltrexone exposure is 3- to 4-fold higher in a single dose of Vivitrol 380 mg compared to daily oral dosing of 50 mg.
Significant Risks
Risk of opioid overdose
Severe reaction at the injection site
Sudden opioid withdrawal
Liver damage
Hepatitis
Benefits
Easy to administer
Long acting
No risk of abuse
Little to no side effects
Not addictive
Proven to be effective
Does not cause withdrawals
Contraindication

If you are using or have a physical dependence on opioid-containing medicines or opioid street drugs, such as heroin, do not use Vivitrol. Tell your healthcare provider if you have liver problems, hemophilia, kidney problems, or any other medical conditions.

Call 911 or get emergency medical help right away in all cases of known or suspected opioid overdose, even if naloxone is administered.

Side Effects
Depressed mood
Suicidal thoughts
Suicidal behavior
Pneumonia
Serious allergic reactions
Nausea
Sleepiness
Headache
Dizziness
Vomiting
Decreased appetite
Painful joints
Muscle crams
Cold Symptoms
Tootache
How it works?
Vivitrol contains an opioid antagonist called Naltrexone that blocks opioid receptors and decreases the euphoric effects of opioids and alcohol. The dosage of Vivitrol is administered once a month as an intramuscular injection in the buttocks. Since Vivitrol is a non-narcotic, there is no potential for misuse. Choosing the shot versus the pills has considerable benefits when it comes to compliance since there is no way to remove Vivitrol from the body after the shot is administered. Additionally, most people experience no side effect from Vivitrol and those who do, only report mild to moderate symptoms, including nausea, headache, depression, anxiety, and fatigue.
Indications
Vivitrol is recommended for patients who are unable to abstain from alcohol and opioid use.
Contraindications
Vivitrol is not recommended if you are receiving opioid analgesics, have a current opioid dependence or experiencing acute opioid withdrawal, have failed the naloxone challenge test, have a positive urine screen for opioids, have exhibited hypersensitivity to naltrexone or any other components of its diluent.
Vulnerabilities
After opioid detoxification, patients are likely to have a reduced tolerance to opioids. Therefore, any use of previously tolerated doses of opioids could result in potentially life-threatening opioid intoxication such as respiratory compromise or arrest, circulatory collapse, etc.
Side Effects
Vivitrol injections may be followed by pain, tenderness, induration, swelling, erythema, bruising, or pruritus; and severe reaction in some cases. The side effects seen most frequently in association with Vivitrol therapy for alcohol dependence include nausea, vomiting, injection site reactions, arthralgia, arthritis, or joint stiffness, muscle cramps, dizziness or syncope, somnolence or sedation, anorexia, decreased appetite or other appetite disorders. The side effects seen most frequently in association with Vivitrol in patients with opioid dependence include hepatic enzyme abnormalities, injection site pain, nasopharyngitis, insomnia, and toothache. Cases of hepatitis, clinically significant liver dysfunction, depression, suicidality, pneumonia, anaphylaxis, and interference with laboratory tests have been observed.
Precipitations
Withdrawal may be precipitated abruptly by administration of an opioid antagonist to a patient with opioid dependence, which may require hospitalization. An opioid-free interval of 7–10 days is recommended. Patients transitioning from buprenorphine or methadone may be vulnerable to precipitated withdrawal for as long as 2 weeks.
Co-pay Savings Program

Some patients may qualify for a co-pay or deductible expense of up to $500/month. The patient must be 18 years or older, have a prescription for Vivitrol, have commercial health insurance or pay with cash. Patients using federal or state healthcare programs, including Medicare Part D or Advantage plans, Medicaid Managed Care or Alternative Benefit Plans under the Affordable Care Act, Medigap, Veterans Administration, Department of Defense, TRICARE, State-funded programs are not eligible for the savings program†.

† Other terms and conditions may apply.

This is only a summary of the most important information about Vivitrol.
BUPRENORPHINE
Suboxone Treatment
Suboxone is a prescription medication containing buprenorphine and naloxone. Suboxone comes in both tablets and a sublingual film, which is placed under the tongue and dissolves quickly to enter the bloodstream rapidly. Suboxone eliminates the “high” or intense feeling of euphoria experienced by patients who abuse opioids. Suboxone treatment is a program that also includes behavioral therapy.
What is Suboxone?

Suboxone combines buprenorphine and naloxone to chemically decrease the severity of withdrawal symptoms in patients with opioid dependence. Buprenorphine binds to brain receptors that are activated by opioids and and block the so that opioid-type drugs cannot stimulate them and create euphoria. Naloxone blocks the effects of opioids in patients who use opioids while taking buprenorphine and prevents the “high” that would come from the relapse. Suboxone is FDA-approved for the treatment of opioid use disorder.

Advantages & Disadvantages

Suboxone treatment lowers the urge to use opioids, drug cravings, chances of relapse, opioid withdrawal symptoms. There are small risks associated with Suboxone treatment: Suboxone can interact dangerously with alcohol. Suboxone must be taken daily and is requires participation in a comprehensive addiction treatment program for it to be effective..

How it works?
Suboxone comes in both tablets and a sublingual film, which is placed under the tongue and dissolves quickly. This allows the medication to enter the bloodstream rapidly. Suboxone tricks the brain into thinking that it is receiving a full dose of an opioid, while naloxone blocks the activation of opioid receptors, thereby reversing the euphoric effects of buprenorphine.
Side Effects
Numb mouth
Nausea
Vomiting
Sweating
Painful tongue
Dizziness
Fainting
Irregular heartbeat
Insomnia
Blurry vision
Back pain
Drowsiness
Difficulty concentrating
Anxiety
Depression
Indications
Suboxone is used to treat opioid addiction in adults.
Contraindications
Do not take Suboxone with other opioid medicines, benzodiazepines, alcohol, or street drugs. Do not inject Suboxone sublingual film, stop it suddenly, or switch to other medicines that contain buprenorphine without talking to your healthcare provider.
Contraindications
Tell your healthcare provider is you have trouble breathing or lung problems, Addison’s disease, an enlarged prostate gland, problems urinating, liver, kidney, or gallbladder problems, alcoholism, a head injury or brain problem, mental health problems, adrenal gland or thyroid gland problems, tooth problems, are pregnant or plan to become pregnant, are breastfeeding or plan to breastfeed.
Side Effects
Suboxone can have serious side effects, including trouble breathing, sleepiness, dizziness, problems with coordination, physical dependence or abuse, liver problems, allergic reactions, opioid withdrawal, decrease in blood pressure, infertility, headache, nausea, vomiting, constipation, pain, increased sweating and insomnia.
Copay Assistance
Copay Assistance is valid only for patients with private insurance who are prescribed Suboxone for on-label use. Patients with government insurance are not eligible for the Assistance Program, including, but not limited to, Medicare, Medicaid, Medigap, VA, DOD, TriCare, CHAMPVA, or any other federally or state funded government-assisted program.
Eligible patients using insurance*
Eligible patients not using insurance