Opi­oid ad­dic­tion treat­ments face off in U.S. trial

Santa Fe New Mexican - - NATION & WORLD - By Carla K. John­son

CHICAGO — The first U.S. study to com­pare two treat­ments for opi­oid ad­dic­tion finds a monthly shot works as well as a daily drug to pre­vent re­lapse.

The shot re­quires days of de­tox first and that proved to be a stum­bling block for many. For those who made it past that hur­dle, the shot Viv­it­rol worked about the same as an older treat­ment, Subox­one.

Both drugs had high re­lapse rates and there were over­doses, in­clud­ing fa­tal ones, in the ex­per­i­ment in 570 adults. The study, pub­lished Tues­day in the journal Lancet, is the first to com­pare the two drugs in the United States, where an opi­oid ad­dic­tion epi­demic has doc­tors and pol­i­cy­mak­ers deeply di­vided over treat­ment strate­gies.

Many ad­dic­tion treat­ment pro­grams don’t of­fer ei­ther med­i­ca­tion, or only one of them.

“Let’s not keep ar­gu­ing about the ex­act bat­ting av­er­ages of th­ese two things,” and make them more avail­able, said study co-au­thor Dr. Joshua Lee of New York Univer­sity School of Medicine.

Pres­i­dent Don­ald Trump re­cently de­clared the cri­sis a na­tional pub­lic health emer­gency. Over­doses, most in­volv­ing pre­scrip­tion painkillers and other opi­oids, killed 64,000 peo­ple in the United States last year.

“Ad­dic­tion medicine physi­cians are hun­gry to get data, es­pe­cially from head-to-head comparisons like this one,” said Dr. Joseph Gar­bely of Penn­syl­va­ni­abased Caron Treat­ment Cen­ters, who wasn’t in­volved in the re­search.

A smaller Nor­we­gian study, pub­lished last month, also found the two med­i­ca­tions work equally well.

The new study re­cruited users of heroin and pain pills from eight de­tox cen­ters across the United States. Half were as­signed to get monthly shots of Viv­it­rol, which con­tains ex­tend­e­drelease nal­trex­one. The oth­ers got daily Subox­one, a buprenor­phine-nalox­one combo in a film that dis­solves un­der the tongue.

Af­ter six months of out­pa­tient treat­ment, in­clud­ing vol­un­tary coun­sel­ing, 65 per­cent of the Viv­it­rol group had re­lapsed com­pared to 57 per­cent of the Subox­one group. Any­one who dropped out of the study was scored as hav­ing re­lapsed.

The dif­fer­ence in the groups stemmed al­most en­tirely from pa­tients who left dur­ing de­tox for Viv­it­rol. Twenty-eight per­cent dropped out be­fore get­ting Viv­it­rol, com­pared to 6 per­cent who dropped out be­fore a first dose of Subox­one.

Of those who ac­tu­ally started treat­ment, about half of both groups re­lapsed.

Viv­it­rol re­quires a pa­tient to fully de­tox first be­cause, if taken too soon, it can cause se­vere and sud­den with­drawal symp­toms. Subox­one can be started sooner, while pa­tients still have mild with­drawal symp­toms.

The re­searchers found no real dif­fer­ence in over­doses. There were five fa­tal over­doses, two in the Viv­it­rol group and three in the Subox­one group. There were 23 non­fa­tal over­doses, 16 in the Viv­it­rol group — half of those in the dropouts who never re­ceived Viv­it­rol — and seven in the Subox­one group.

The two medicines work dif­fer­ently, but both block the pow­er­ful high of ad­dic­tive opi­oids. Treat­ment pro­grams tend to fa­vor one over an­other.

Those pre­fer­ring Subox­one com­pare it to in­sulin for di­a­betes, but oth­ers see it as a crutch be­cause it con­tains an opi­oid that has a mild ef­fect on pain and mood. Subox­one costs about $100 a month. Viv­it­rol costs about $1,000 a month.

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