Making the decision to seek help getting clean from opiates is a huge, scary, and brave step. Once you decide to get clean, the best path forward isn’t always clear. The combination of mental health (counseling, groups, etc.), social support (housing, job, clean friends, etc.), along with Medication-assisted treatment (MAT) provides the most stable structure for your recovery.
Think of the recovery process like a stool. It needs at least 3 legs to stand, right? MAT should be one of those legs. How do you decide between Vivitrol and Suboxone? This article explains the difference between the two and the considerations for each approach.
What is Suboxone?
Suboxone contains two drugs, buprenorphine and naloxone. Buprenorphine is an opiate medication. It binds to opiate receptors and has the same general effect as other opiates, like morphine or fentanyl. What makes buprenorphine stand out is the ceiling-effect.
The ceiling-effect means there are typical opiate effects as the dose increases, but only to a moderate level. After the point of maximum effect, increasing the dose does not cause increased euphoria or pain reduction like other opiates.
Because of the ceiling-effect, buprenorphine does not exhibit the same tolerance along with escalating dose seen with the widely abused opiates. Due to its unique activity, once a sufficient dose is reached, the dose typically stays stable for as long as the medication is used.
Suboxone is a film that dissolves in the mouth. It is held under the tongue and is absorbed sublingually (under the tongue). Naloxone, commonly known as the emergency overdose drug, is not absorbed well sublingually. Naloxone is present to avoid abuse of Suboxone by injection. Upon injection, naloxone blocks the effect of buprenorphine. This keeps the medication being used for its intended purpose.
What is Vivitrol?
Vivitrol is an injectable formulation of naltrexone that lasts for 1 month. The easiest way to understand naltrexone is to think of it like naloxone, with the difference being, naloxone wears off much faster. The half-life of naloxone is 30-90 minutes. The half-life of naltrexone is ~4-10 hours and slowly wears off over a period of 96 hours.[R]
Naltrexone is available in pill form. However, this means that the medication needs to be taken daily. In contrast, Vivitrol is injected as a liquid. It then solidifies, essentially turning into a pellet that slowly dissolves over the course of a month.
Vivitrol is not an opiate medication. In contrast to Suboxone, Vivitrol blocks opiates from binding to the receptor, eliminating the ability to get high from them. Likewise, opiates will no longer help with pain while on Vivitrol.
Considerations for Vivitrol and Suboxone
Most importantly, both medications are highly effective for as long as they’re used. You can’t go wrong in that sense. There are, however, considerations to take into account when deciding which medication may be best suited for you.
Probably the number one consideration is that Suboxone is an opiate. As with any other, you will be dependent upon it. Meaning, if you don’t take the medicine regularly, you’ll experience withdrawal symptoms. For most people this isn’t a problem, because they take their medicine regularly. There are three scenarios where this is necessary to take into account.
- You have difficulty remembering to take daily medicine; sometimes 2-3 times a day
- Missing your required monthly appointment for refill
- Traveling for an extended period of time
- Future plans of weaning and stopping the medicine (very doable, but there are typically uncomfortable periods during weaning)
Being that Suboxone is a daily dose, and it comes as a dissolvable film, dose adjustments are very easy to make. The films also have perforations to divide them to your exact dose. Therefore, dose changes you and your doctor decide on are easy to implement.
Suboxone usually eliminates, or substantially reduces, cravings because the medication took place of the other drug being used. Essentially, instead of filling the craving and addressing withdrawal by using more heroin, Suboxone is now in its place in a regular regimen.
One of the nice things about Vivitrol is you get the shot and then you don’t have to think about it again for a month. Most people report very little physical craving for opiates while on naltrexone. Craving the high to ease anxiety and emotions may still be present but this is why a support team like at Mindful Care is essential. Instead of a band-aid approach, you'll receive effective soothing strategies and begin to engage in the healing process.
Vivitrol injections are somewhat painful. The injection goes in the glute muscle. The site is usually sore for a couple of days. Luckily, there is no need to avoid any activities afterward and within a few days most people don’t notice anything.
Vivitrol cannot be removed. A common concern is whether anything could be done in an emergency situation for pain. There are options other than opiates for acute pain but opiates are not an option. Their effect would be blocked by the naltrexone. It’s recommended to carry a card, wrist band, dog tags, etc. provided by Vivitrol, to alert EMS and others in the event of an emergency, so they know not to give morphine.
The number one warning anyone receiving naltrexone needs to know is the dangers of relapse and trying to take enough to get high. The risk of taking so much heroin/morphine/etc. to get high while on Vivitrol is that you would most likely overdose at the point you could potentially overcome the medication.
Many people relapse while on Vivitrol. Usually, the person uses, they don’t get high, they realize they wasted their money, and they continue on their recovery journey. Vivitrol acts a bit like a “relapse security blanket” in this way. Relapse on Vivitrol doesn’t lead to re-entry into the cycle of addiction and dependence that it normally might - so long as you keep showing up for your shot each month.
Vivitrol carries a risk of liver problems but this is primarily in people with pre-existing liver issues.
The Starting Procedure of Suboxone vs. Vivitrol
Suboxone induction (starting on the medication) involves stopping your other drug and showing up at the clinic in withdrawal. The doctor will then give you a small starting dose of Suboxone, then check your withdrawal symptoms after some time. If withdrawal symptoms are still present, they give more Suboxone. It goes like this until withdrawal stops. This is how the doctor finds the dose of Suboxone needed sufficient to “match” the dose of your other drug. This will be your daily dose.
Vivitrol, on the other hand, cannot be started until you have completely detoxed. This does not necessarily mean completing a detox program. It means when you have a negative drug test. You can feel better before actually being fully detoxed. If Vivitrol is given prior to complete detox, precipitated withdrawal will happen which can be potentially dangerous and extremely intense, depending on how much detox of your body is left.
How long should you be on Suboxone or Vivitrol?
There is no set rule. Some people take Suboxone for many years with no plan or desire to stop what’s working. Other’s want to wean eventually. Vivitrol is the same story. At least a year on MAT makes logical sense. You need time away from high doses of opiates to let your brain recalibrate, and do the mental and emotional healing work necessary to remain clean.
Mindful Care has a specialized team ready to walk with you in your recovery journey. Connect with us today. You are not alone.