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Medication assisted treatment references the ability to utilize medications in managing cravings. Several methods of medication assisted treatment (MAT) exist and are dependent upon the substances being used and the end goal of treatment in reference to which avenue of treatment is chosen. Common methods of MAT include Vivitrol, Naltrexone/Rivea, Suboxone, Sublocade and Methadone. For the purposes of this discussion, we will be looking to compare and contrast Vivitrol and Suboxone in an effort to ensure that clients and loved ones have a firm understanding of what is being offered prior to making the determination to partake in its usage. While MAT offers many benefits, it is not without its risks and should not be entered into lightly. When utilized in conjunction with therapy and behavioral interventions, the use of MAT can greatly increase the success rate in the recovery of substance abuse. Both Vivitrol and Suboxone aim to aid in the treatment of opioid abuse, as the two substances act similarly upon the same receptors. However, Vivitrol has the added benefit of further protecting against alcohol consumption.

 

Deciding To Seek MAT

 Part of making the determination to utilize medication assisted treatment requires the decision to abstain from utilizing any nonprescription mind and mood altering substances, as continued use greatly increases those risks associated with the medications (to be discussed later within this article).  Prior to determining whether Vivitrol or Suboxone would be most appropriate for treatment, it is first essential to answer two questions, the first being, are you trying to treat alcohol usage, opioid usage or both? If the answer is solely alcohol or both alcohol and opioids, than Vivitrol will be the only option available, as this is the only one of the two discussed medications that works upon both substances. However, if the answer is opioids alone, than you are confronted with a second question. The individual must make the determination as to whether or not they are looking to maintain complete abstinence from use or to maintain a safe dosage monitored by a licensed physician.

 

While it may seem perplexing to maintain use when discussing recovery from substances, there are several reasons why an individual may choose to do so, particularly early on in the recovery process. For each individual their usage may stem from different contributing factors. For an individual who may suffer from chronic pain, complete abstinence from opioids may be difficult to maintain, with this pain serving as a constant trigger. Suboxone, as well as Methadone (which is outside of the scope of this article), offer the ability to refrain from the purchasing of opioids from the street and thus, limit the risk of uncertainty in the product that is being received.  Additionally, it allows for medical intervention, where a licensed physician works to determine an appropriate dosage for the user based upon their previous use, as well as any extenuating factors. Suboxone limits the likelihood of relapse in this manner and offers peace of mind to the client and their loved ones.

 

About Suboxone

Suboxone works by partially blocking the opioid receptors in the brain. It is as if it is allowing the reward system in the brain to only receive a portion of the reward it is seeking. This allows for the reward system to be pacified, without flooding the receptors that would allow the individual to become high. Suboxone further decreases the likelihood of overdose through one of its active ingredients, Naloxone. This is the same active ingredient found in Narcan that counteracts the effect of the opiate (National Alliance on Mental Illness, 2020). Suboxone is taken daily and is available as a tablet or a strip, which will be provided by the clinic once the dosage has been determined through the physician. While The Naloxone within the Suboxone reduces the risk of overdose, an individual taking Suboxone should still take care not to utilize additional opioids, as this may increase the risk of overdose. It should be noted that because Suboxone works to provide the reward system with “a taste” of the substance it is seeking, in this case, opioids, it is also addictive by its very nature and can cause withdrawal symptoms if stopped suddenly. Generally speaking, when an individual decides to seek complete abstinence (the absence of any and all substances), it is done so in stages, with the dosage being slowly lessoned before stopped entirely.

 

Given that Suboxone is provided in the form of strips or tablets, it does create the concern of being able to be shared with others or sold on the streets. For that reason, Sublocade has been introduced as an additional option for delivering Buprenorphine, the active ingredient in both Suboxone and opioids. Unlike Suboxone, Sublocade functions as an injection and is provided once monthly, offering a slow release of the same active ingredients, but without the possibility to be shared or abused (The Recovery Village, 2020).  While Sublocade would seem to be an obvious choice, less is known about its long-term success rates, as it is a relatively new medication.

 

About Vivitrol

Unlike Suboxone, Vivitrol works by entirely blocking the effects of opiates and alcohol alike. It interferes with the ability of both substances to enter into the reward system, thereby eliminating ones ability to feel intoxicated by usage while on Vivitrol (“Vivitrol”, 2019).  With that being said, it does not impact the amount of substance that enters into the bloodstream, only the ability of the user to feel the euphoric effects. Thus, when choosing to utilize Vivitrol, it is important to recognize the risk of overdose, should one continue to use. The idea behind Vivitrol is that should an individual “slip,” they would likely recognize their inability to break through the wall created by the injection within their brain and return to working on their sobriety. Vivitrol is also offered in a daily pill, known by either Naltrexone or Rivea, but maintaining the same active ingredients. However, this creates the ability for the client to choose to refrain from taking their pill that day should they desire to use or consume alcohol, whereas Vivitrol offers coverage for the entirety of the month.

 

Making A Decision

Medication assisted treatment can be a beneficial tool to utilize when seeking recovery. It should not be used alone and is not meant to be a replacement to therapy or other interventions. MAT allows the individual entering into recovery to quiet the noise within their reward system, while actively working to build healthy coping mechanisms, a positive support system and further exploring their triggers. In response to Vivitrol, it is likely that an individual would be prescribed a monthly dosage anywhere between several months to eighteen months, whereas Suboxone is often prescribed on lengthier terms dependent upon the rationale to its usage. Regardless, neither product is a substitute for the effort required to seek and maintain recovery.

 

Resources:

National Alliance on Mental Illness. (2020, February). Buprenorphine/Naloxone

(Suboxone). Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone)

The Recovery Village. (2020, January 23). Sublocade. Retrieved from

https://www.therecoveryvillage.com/treatment-program/addiction-

medications/sublocade/#gref

Vivitrol (naltrexone for extended-release injectable suspension).

(2019, July). Retrieved from

https://www.vivitrol.com/opioid-dependence/how-vivitrol-works