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PostPosted: Thu Dec 17, 2015 5:07 pm 
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My son (29-w/10yr opiate addiction) has been on Suboxone for 14 months unsuccessfully. He started out at 16mg and tapered down to 4mg over 6 mos with the idea of getting Vivatrol shots.
Fell off the wagon at 4 mg and went on a snorted H bender. I figured it out and started administering 16mg (meeting up twice a day to give it to him.) Tapered again to 12mg and used Roxy. Back to 16 now to 12 mg again. Been on this for 3 months.

His Dr says he obviously can't taper and plans to give him a Vivitrol shot next week. This is a pretty reputable practice/clinic and Dr says he has given the shot to lots of patients at anywhere from 16 and down.
There is another patient in my son's weekly group that got the shot at 16mg two months ago. Said it was really bad.
Has anyone had any experience with this? I'm sure the precipitated WD will be tough but son has lots of experience with regular wds and precipitated with Sub 3 times in rehab.
Seems a bit iffy to me.


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PostPosted: Thu Dec 17, 2015 5:58 pm 
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Sounds sadistic but I haven't done this. Currently it is recommended to be off all opiates, 7-10 days, small test dose of naltrexone. If no reaction (withdrawal) then 3 doses of oral naltrexone before the Vivitrol injection.
More information here, {spoiler alert, manufacturers propaganda} http://www.vivitrol.com/


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PostPosted: Thu Dec 17, 2015 8:05 pm 
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Last time I went on naltrexone, I got an implant. I was given 2 small test doses in the hours before the procedure. The test doses precipitated withdrawal. I remember I started shaking, and had to run to the toilet a couple of times. My doctor suggested we postpone the procedure, but I insisted we go ahead because I didn't want to wait another 2 days and risk using heroin.

I was on 4mg of Suboxone and took my last dose the day before the procedure. I had also used heroin 5 days prior.

The naltrexone made me VERY sick. I couldn't function for 2 or 3 days. I remember I shat my pants two or three times, hardly ate, and was confined to the couch. My brother came over to my flat and basically took care of me for a couple of days. I also I had to work in a cafe 2 days later, and I was still very sick by that time. I think I shat my pants at work it was still that bad.

Now that sounds pretty bad. But there was an upside. I actually got well REALLY fast compared to a traditional suboxone detox. I was feeling better and functioning by day 4-5, rather than by day 12. I also COULD NOT use any other opiate for relief because of the naltrexone, so I was basically forced to push through the withdrawal.

Looking back, despite the intensity of the sickness, I would probably go through it again. Naltrexone is much more liberating to be on than Suboxone, because you're not actually dependent on it. I didn't need to take my dose every day, and I could go to NA and identify as "clean".

I've never been on Vivitrol, but I have read a lot about it. If your son is still motivated to use, as it appears he might be, he may try to use when the injection wears off, between day 24-30. If he gets an effect, it can actually be quite dangerous because he'll have no tolerance. This is the reason why naltrexone is considered the more dangerous option than agonist replacement therapy like methadone/Suboxone. Risk of mortality is actually increased by going on naltrexone. So it's important he does something to keep motivated in his recovery. SMART recovery, a dayhab program, NA, exercise. Whatever. Also, people can be on naltrexone for many months and, the moment they stop taking it, go out and use. If you're going the naltrexone route, I'd stick use it for years rather than months.

Good luck


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PostPosted: Fri Dec 18, 2015 9:07 pm 
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If he takes Vivitrol a week after stopping buprenorphine, he will get very sick. Even the guidelines for being off opioids for two weeks are intended to apply to opioid agonists like heroin or oxycodone-- drugs that have half-lives much, much shorter than buprenorphine.

Yes-- I suppose there is a chance that he will get the Vivitrol, feel like death, crap his pants, and then come around to an attitude of recovery, as Tee Jay describes. Or, me may do what most people do-- which is desperately search for enough heroin to make the sickness stop. Taking agonists to overcome injections of naltrexone is DANGEROUS--- much more dangerous that regular heroin use. The person ends up using high doses of heroin, and at some point the balance is tipped toward displacement of naltrexone. At that point, the large amount of heroin or oxycodone on board can easily be enough to stop respiration, and cause death.

But my problems with Vivitrol, and with naltrexone, go much further than concerns about the first few days. Vivitrol was first approved for alcohol dependence. A couple years after that indication, the company took advantage of the surge in overdose deaths to seek an indication for opioid dependence. There is a general assumption that people can take Vivitrol, get cured by a shitload of counseling, and then stop the Vivitrol and live happily-ever-after. But there is no evidence that such a story makes sense.... and plenty of evidence that the idea is only a fairy tale. We know, for example, that counseling does not decrease relapse rates for patients on buprenorphine. That fact has been demonstrated in several studies, and while it is inconvenient, it is the simple fact of the matter. Beyond that, Vivitrol patients can be divided into the people taking the medication voluntarily, vs the ones forced to take it by a drug court. Is it logical to think that person forced to take an opioid blocker, for a known length of time, is going to find 'recovery'? Or is it more likely that the person will resent the blocker, repeatedly test the blocker, and use as soon as the blocker is no longer mandated?

Nobody seems to think about the patients who started Vivitrol, then stopped coming in for an injection. What happens to those people? Or what happens to the people who finish a year on Vivitrol and walk off into the sunset? Australian studies followed people on naltrexone who eventually stopped naltrexone, and found that those people had a very high rate of death. When people stop naltrexone, they have 'reverse tolerance'-- i.e. their mu receptors are very sensitive to opioids, both in regards to getting high, and in regards to death by overdose.

When patients are forced by the court to take Vivitrol, and then six months later the Vivitrol is stopped, and those people know that if they used they would experience the strongest opioid effects that they've ever experienced, what is the chance that they WON'T use?

We don't know-- because nobody looks. And of course they will never look, because the answer would only destroy the chance that the drug will ever be used.

My chief reason for disliking Vivitrol is because it is a SHORT TERM treatment for a LONG TERM illness. And there is evidence to suggest that the short-term treatment, Vivitrol, increases the death rate of the long-term illness of opioid dependence.


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PostPosted: Sat Dec 19, 2015 9:40 pm 
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What Dr. J said mirrors my experience somewhat. I had purchased a 6 month implant, and it ended up wearing off after between 3 and 4 months. This was nowhere near enough time. I noticed cravings return, and I had a shot of heroin expecting it to be blocked completely. And it worked. I got so stoned it was probably dangerous. And when I saw my doctor and told him I'd started using, he said he wasn't getting any new implants in until early 2016, so he put me back on Suboxone. Which is basically why I'm back on this forum today.

Like Suboxone, if you're going down the naltrexone road, I'd suggest staying on it for years rather than months. Hell even if you have to take it for the rest of your life it's still worth it in my opinion.

I'm doing okay on Suboxone for now. But I do envisage getting another implant some time down the road, perhaps as a "step-down" and safety-net once I decide to ween off Suboxone.


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