The three most popular drugs currently on the market for opiate addiction (prevention, and management) are Suboxone, Subutex, and Vivitrol; Methadone is still around too, but is no longer the only or preferable treatment for opiate abuse. The difference between Suboxone and Subutex is that Suboxone contains an opiate blocking substance called naltrexone, and Subutex does not. Vivitrol is naltrexone, just in an injectable form; naltrexone is also available as a daily pill, which is the cheaper, but not iron clad option. There are pill forms, as well as films that dissolve in the mouth, and Vivitrol as mentioned above is injected in shot form. There is a high chance of dependence and abuse with both Suboxone and Subutex, as they do not rule out abusing all narcotic substances, only alcohol and opiates; they themselves are also abusable. Although these two medications are used in substance abuse medical detox, and in the beginning stages of many opiate addicts and alcoholics recovery, it is advised to be highly cautious of their addictive nature. Vivitrol does not have the buprenorphine in it, so is not abuse-able or habit forming. So why take Suboxone or Subutex at all, why not just stick to the blocker Vivitrol you ask? Well because for some people in end stage addiction, or that also suffer from chronic pain conditions, it ends up being about management versus abstaining from opiates completely; cost is a big factor for many as well, as Vivitrol is quite expensive.
May 26th, 2016 the FDA released Probuphine, a buprenorphine implant, the first buprenorphine implant and longest lasting dose yet; the implant lasts 6 months, vs. having to get it monthly or taking something daily. This is the latest component released as part of the FDA’s opioid action plan. The purpose of these drugs is to help addicts and alcoholics alike abstain from opiates and/ or alcohol for as long a period of time as possible. While reducing cravings, and essentially blocking the opiate receptors in the brain from being able to get high or drunk, even if they were to ingest opiates or alcohol. This prevents the addicts/ alcoholics from abusing their medication by taking more the prescribed, from selling their medications (which have a high street value these days), and from being able to decide whether or not they want to keep taking it at all.
Besides the length of time it is in the body, and preventing opiate and alcohol abuse, what are the other positive attributes to this new MAT (medication-assisted treatment) option? Since it is in implant form, the medication can gradually be released, helping the body with medication compliance. As recommended for all of these MAT’s, pairing them with substance abuse treatment, and outside support groups such as Alcoholics Anonymous gives the individual the most bulletproof recovery plan.
Why do many think this latest MAT will not be successful, and is not a very versatile option in treating opiate addiction, withdrawal, and continued recovery? Probuphine can only release a maximum of 8mg of buprenorphine a day, which for many, especially in early recovery, is not enough. With the 6-month window, patients and their progression are not monitored as closely, only having to see their doctors every 6 months, instead of every month. The insertion and removal of the implant is a small surgical procedure, and has not been reported to be pleasant going in or coming out. So we see there are positives and negatives to this new MAT option, and again it boils down to individual preference, finances, and overall treatment plan. There is more information on this new medication, and how to get all the education you need in the links below.
• Why Probuphine Will Flop - Cons of FDA Approval of Probuphine