What Is Vivitrol (Naltrexone) and How Does It Work?

young woman with doctor

Vivitrol is the brand name a medication called naltrexone. Vivitrol is in a category of prescription drugs called medications for opioid use disorder (MOUD), which are approved by the Food and Drug Administration (FDA) to treat people diagnosed with opioid use disorder (OUD). In addition to treatment for OUD, Vivitrol is FDA-approved to treat people diagnosed with alcohol use disorder (AUD).

Vivitrol is a valuable medication to help people with AUD, but it’s an even more important tool in our work to mitigate the ongoing harm caused by the opioid crisis in the U.S. Also known as the overdose crisis or the opioid epidemic, this public health emergency claimed the lives of 932,000 people between 1999 and 2020.

When we add provisional numbers from 2021, that brings the overdose crisis death toll to over a million people. That’s a staggering statistic – and we’re working every day to bring those numbers down.

Here’s the latest nationwide data on the opioid crisis, as reported by the Centers for Disease Control (CDC).

Overdose Fatalities 2019-2021: Overall and Opioids

  • 2019: 67,697 total drug overdose fatalities
    • 50,178 involving opioids
  • 2020: 78,056 total drug overdose fatalities
    • 69,061 involving opioids
  • 2021: 107,306 total drug overdose fatalities
    • 73,453 involving opioids

Those numbers tell us that on average, between 2019 and 2021, three-quarters of overdose deaths in the U.S. involved opioids.

That’s why we use medications for opioid use disorder (MOUD) in the substance use disorder (SUD) treatment centers we operate in Williamson, West Virginia and Laconia, New Hampshire, two states that have experienced significant harm as a result of the opioid crisis.

Here’s the most recent data for West Virginia.

Overdose Fatalities West Virginia 2019-2021: Overall and Opioids

  • 2019: 870 overdose fatalities
    • 665 involving opioids
  • 2020: 1330 overdose fatalities
    • 1,137 involving opioids
  • 2021: 1,553 overdose fatalities
    • 1,201 involving opioids

Here’s the most recent data for New Hampshire.

Overdose Fatalities New Hampshire 2019-2021: Overall and Opioids

  • 2019: 415 overdose fatalities
    • 372 involving opioids
  • 2020: 406 overdose fatalities
    • 357 involving opioids
  • 2021: 381 overdose fatalities
    • 323 involving opioids

West Virginia has the highest rate of fatal overdose in the country, at 81.4 deaths per 100,000 people. New Hampshire has the 23rd highest rate of fatal overdose in the country, at 30.3 deaths per 100,000 people.

These medications – including Vivitrol – are part of an approach to OUD treatment called medication-assisted treatment (MAT).  Before we get into the details on Vivitrol, let’s clarify what we mean we say MAT.

Medication-Assisted Treatment: The Most Effective Available Treatment for OUD

The overdose and opioid crisis is now in its third decade. That means we’ve had time to try a variety of approaches to reducing opioid overdose and preventing relapse to opioids after an individual receives a diagnosis of opioid use disorder.

Research shows that at least three factors are directly involved in the successful treatment, reduction of overdose death, and reduction of relapse rates among people with OUD.

What We Know About Overdose and Relapse Prevention

  1. Initiating treatment within 14 days of diagnosis of OUD reduces overdose and relapse risk
  2. Participating in at least two outpatient visits within 30 days of initiating treatment reduces overdose and relapse risk
  3. Continuous participation in MAT program using MOUD for a minimum of six months reduces overdose and relapse risk

Now let’s get to what we mean when we say MAT. Here’s a simple and clear definition published by the Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT:

“MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”

Benefits of MAT include:

  • Reduced withdrawal symptoms
  • Reduced cravings
  • Decreased euphoric/sedative effect of opioids
  • Reduced overdose rate
  • Reduced relapse rate
  • Decreased infectious disease transmission
  • Increased time-in-treatment

Evidence also indicates participation in an MAT program can:

  • Reduce illegal or criminal behavior related to opioids
  • Lead to better overall outcomes for women with OUD who are pregnant
  • Help people with OUD seek and find jobs
  • Help people with OUD improve relationships with family, friends, and loved ones

That’s a good overview of MAT and the benefits of MAT for people on OUD. Now we’ll shift our attention to one MOUD in particular: Vivitrol.

Vivitrol: How It Works for People with OUD

Naltrexone, the active medication in Vivitrol, binds to opioid receptors in the brain and blocks the effects – particularly euphoria and sedation – of drugs like heroin, morphine, codeine, and oxycodone. It also binds to endorphin receptors to block the euphoric effects of alcohol, which is why Vivitrol is also used to treat alcohol use disorder (AUD) in addition to OUD.

In this article, we’ll focus on Vivitrol for people with OUD, and discuss Vivitrol for AUD in another article at a later date.

We told you how Vivitrol works in general – it blocks the ability of opioids to cause pleasure. Now we tell you how treatment with Vivitrol works.

Vivitrol Treatment: Overview

  1. An individual diagnosed with opioid use disorder (OUD) receives a full assessment and a licensed physician prescribes the medication.
  2. An individual with OUD must stop taking short-acting opioids for a minimum of seven (7) days before beginning treatment with Vivitrol, and stop taking long-acting opioids for fourteen (14) days before beginning treatment. This is important: without detoxification, Vivitrol will trigger withdrawal and lead to uncomfortable withdrawal symptoms.
  3. Once an individual is opioid-free, they can receive their first dosage of Vivitrol and begin official their MAT program.
  4. Vivitrol is delivered through intramuscular injection into the buttocks. Each injection contains 380 milligrams of naltrexone.
  5. Vivitrol is long-lasting: most patients receive one injection per month.
  6. When an individual begins MAT with Vivitrol or any other MOUD, they also participate in therapy, counseling, and various forms of social support to help them recovery from OUD and rebuild their lives.

That last point is crucial to understand: MAT with any MOUD is about more than the medication. MAT programs with Vivitrol also include:

  • Treatment for co-occurring mental health disorders
  • Individual and/or group counseling
  • Lifestyle changes, including healthy eating and regular exercise
  • Vocational training and support
  • Educational training and support
  • Relationship skills development and support
  • Connection to vital social services to address issues such as homelessness, food insecurity, and the need for general medical care

The goal of these additional supports is to help people with OUD rebuild their lives. The goal of the medication is to prevent cravings and block the action of opioids in the brain so that if an individual takes opioids while on Vivitrol, they will not work. In addition, the medication reduces cravings and allows an individual with OUD to participate fully in the aspects of treatment that allow them to participate in the life-affirming supports we list above.

Before we close, we’ll discuss the potential complications, risks, and side-effects people on MAT with Vivitrol need to know about.

Vivitrol: Benefits Outweigh Risks

When people take Vivitrol as part of a federally licensed MAT program, they may experience the following side effects:

  • Injection site discomfort
  • Nausea
  • Diarrhea
  • Drowsiness
  • Muscle or joint pain
  • Constipation
  • Dizziness
  • Irritability

Not everyone who takes Vivitrol experience these side effects. In most cases, these side effects are mild and fade quickly. In rare cases, people can develop pneumonia, depressive mood, and liver problems. Patients who experience those symptoms should contact their physician immediately.

There’s one more risk associated with Vivitrol, and it’s the most dangerous one. Because Vivitrol completely blocks the action of opioids in the brain, and individual with OUD who previously developed a tolerance for opioids loses that tolerance when they’re on Vivitrol.

Tolerance means more of the drug is required for the same effect. Therefore, if a person on Vivitrol waits until the end of their medication cycle – say three weeks to a month after their injection – and decides to use opioids, their tolerance is gone. That means the amount of opioid they previously used to feel euphoria might be far too much, and cause a potentially fatal overdose.

That’s a real risk.

However, the benefits of MAT with Vivitrol are significant. A person on MAT with Vivitrol can rebuild their lives and experience a full and total recovery, free from the painful cycles of opioid addiction. That’s why – when used properly – Vivitrol can be both a lifesaving and a life-changing medication.