Revia and Vivitrol Vs. Suboxone – Suboxone and naltrexone (Revia and Vivitrol) are medications approved by the Food and Drug Administration for the treatment of opioid addiction. Both have been clinically proven to be beneficial for those entering recovery, but which one may be more appropriate or helpful for each individual depends on their personal needs and, sometimes, the severity of their addiction.
What Is Suboxone?
Suboxone contains two medications: buprenorphine and naloxone (not to be confused with naltrexone). Buprenorphine is an opioid used to treat addiction to other opioids and withdrawal symptoms. It can be administered sublingually (under the tongue) in films or tablet form or as a once-a-month, extended release injection (Sublocade). Naloxone is an opioid antagonist that is commonly used on its own to reverse opioid overdoses.
As an opioid, buprenorphine attaches to the body’s opioid receptors, but unlike heroin or prescription painkillers, it activates these receptors only partially. That means that the maximum or “ceiling” effects of buprenorphine, such as euphoria, do not occur as frequently and at a considerably lesser intensity than other opioids. For this reason, medications that contain buprenorphine can mitigate cravings and symptoms of opioid withdrawal with much less potential for abuse than other opioids, such as heroin.
Naloxone, the other component in Suboxone is included as an additional means to prevent abuse and overdose.
Benefits of Suboxone
Withdrawal from heroin and other opioids can be incredibly unpleasant and even painful. Suboxone minimizes withdrawal symptoms and cravings, two main instigators for relapse. It allows people in this phase to feel much better and reduce their suffering so they can better focus on the early recovery process.
Potential Disadvantages
Because it is an opioid, buprenorphine can, in some cases, be abused. If this occurs, a condition known as precipitated withdrawal can result.
Precipitated withdrawal occurs when a full or partial antagonist, such as buprenorphine, is administered to a patient dependent on full agonist opioids, such as heroin. Buprenorphine has both a high affinity for and low intrinsic activity on opioid receptors, so it displaces agonist opioids from these receptors without activating the receptor to an equivalent degree.
The inclusion of naloxone in Suboxone typically helps to prevent this from happening when used appropriately, but this can occur if the medication is dissolved and injected or smoked by a person tolerant to opioids. Moreover, health providers must have a waiver to prescribe buprenorphine, and the number of patients that a physician can treat for opioid addiction is restricted by law. Therefore, some physicians may not always be able to prescribe this medication to new patients.
What Are Naltrexone, Revia, and Vivitrol?
Naltrexone is a medication that does not activate receptors and instead blocks the effects of opioid medication, including pain relief or feelings of euphoria that can promote opioid abuse. Naltrexone is commonly used as part of a long-term treatment program for opioid dependence. Naltrexone both minimizes cravings for opioids and prevents users from getting high if they relapse and return to drug use.
Also, because naltrexone is not technically an opioid, there is no potential for misuse. For this reason, there are no special prescribing regulations placed on health providers, and it tends to be more commonly used in drug courts and prison systems. Many people who are skeptical of medication-assisted therapy for drug abuse appreciate the fact that naltrexone is not addictive and thus does not “replace one addiction with another.”
However, because naltrexone can cause precipitated withdrawal, it must only be administered after opioids have been eliminated from the body, unlike Suboxone. Of note, for reasons that aren’t entirely clear, naltrexone may also be beneficial for the treatment of alcoholism, as it reduces the euphoric effects that alcohol can produce, thus making drinking less appealing.
Revia is a form of naltrexone that is taken in pill form once per day. This method may be more appealing to some than a painful shot (Vivitrol), but it also has a higher potential for relapse because individuals on a regimen can simply decide to stop taking it and return to drinking as normal. Vivitrol is an extended-release injection that can be administered once a month and has the same effects as Revia or oral naltrexone.
Disadvantages of Revia and Vivitrol
Before beginning Vivitrol or Revia, a person must go through a full opioid detox several days in advance, which can be very challenging to do without other medications or professional treatment. Naltrexone can reduce opioid tolerance and cause increased sensitivity to the same, or even lower doses of opioids, increasing the risk of overdose if a person relapses.
Vivitrol has advantages over Revia because once a shot is administered, a person cannot forgo their daily medication in favor of relapse. For this reason, Vivitrol has somewhat better patient compliance than oral naltrexone. Also, for some, it is more appealing than taking a pill every day. However, if during this time the person requires opioid therapy for severe pain, such as that related to an emergency situation, special measures will need to be taken.
Finally, the Vivitrol is both expensive (costing $1,000 per shot for private insurers and $500 per shot for Medicaid) and can be painful for the patient. Indeed, it also associated with several unpleasant temporary side effects. Moreover, Revia may be a better option for those who struggle with insurance coverage or are averse to needles or receiving shots in general.
So Which Approach Is Best?
Suboxone and naltrexone in either form both have pros and cons. The best recovery medication depends on each person’s situational needs and recovery goals.
On the one hand, Suboxone, if available from a prescriber, can help people reduce cravings and withdrawal symptoms in detox early in the recovery process. Naltrexone, on the other hand, is more easily accessible for some and may serve them better over the long haul (perhaps years, if necessary) for the prevention of relapse. For some, the ideal long-term treatment plan may include both Suboxone and Vivitrol or Revia.
Research: Vivitrol vs. Suboxone
Recent research that studied the efficacy of Suboxone vs. Vivitrol head-to-head found they were equally effective at reducing cravings and treating addiction. However, the 7-10 day detox period before Vivitrol treatment could be administered prompted some users (25%) to end their participation in the study. Conversely, only 6% of participants who were to be treated with Suboxone dropped out before they received their first dose.
The study, which was published in The Lancet and funded by the federal government, followed 570 people with opioid use disorder over the course of six months. The study found that 52% of subjects treated with Vivitrol relapsed during that time, compared with 56% of people treated with Suboxone. And while the two medications were found to be almost equally effective, there was still a high rate of relapse for both in the study.
Treatment for Opioid Addiction
People who choose treatment programs that use medication-assisted therapy may benefit from the use of either Suboxone or a form of naltrexone, or both. In addition to medication, however, it has been clinically shown that outcomes are improved for those who also receive evidence-based services as part of the recovery process, including psychotherapy, counseling, and group support.
Recovery By The Sea offers an integrated approach to addiction and employs highly-skilled addiction professionals who render therapies to our clients with care and expertise. We are dedicated to providing each client with the tools and support they need to achieve a full recovery and experience long-term wellness and sobriety.
If you or someone you love is addicted to opioids, other drugs, or alcohol, contact us today. Find out how we help people regain their health and sanity, and enjoy the rest of their lives free from addiction!