Improving Compliance: New Long-Term Treatments for Opioid Addiction on Horizon

Compliance to daily drug regimens has been an ongoing challenge in opioid-addiction treatment, but, as outlined in an Oct. 21 Associated Press report, emerging long-term therapies may provide an effective solution.

Daily methadone or buprenorphine has been the standard of care for patients addicted to heroin or prescription pain medications. Both drugs effectively suppress withdrawal and cravings, but sticking to daily treatment is difficult for many patients, and missed doses can lead to relapse. Buprenorphine is also a take-home drug, and diversion is a growing problem.

On Oct. 12, the Food and Drug Administration (FDA) approved Vivitrol, a once-monthly shot manufactured by Alkermes, Inc., for treating opioid addiction. Vivitrol is said to effectively suppress the ?high? associated with opioid use. Vivitrol?s active ingredient, naltrexone, is not addictive and has been used to treat alcohol addiction for years.

Another long-term drug on the horizon is Probuphine, a match-sized implant from Titan Pharmaceuticals that releases low doses of buprenorphine for up to six months. Although research into Probuphine?s safety and effectiveness is ongoing, it may be up for FDA approval as early as next spring.

Long-term therapies aren?t the answer for all opioid-addicted patients. More than 50 percent of patients in a clinical trial of Probuphine had a reaction at the implant site, according to the article in the Journal of the American Medical Assocation. Site reactions were also reported for Vivitrol, as were more serious side effects including liver damage.

Still, both drugs may help patients for whom other options have failed, said Nora Volkow, M.D., director of the National Institute on Drug Abuse.

That’s been true for T. J. Voller, a 29-year-old Westborough, Mass., resident who had only short-term success taking oral buprenorphine to tackle his heroin addiction. Voller, who is now back in college, has received Vivitrol injections for the past year.

“If I didn’t want to take [oral buprenorphine] and wanted to get high, there was nothing to stop me,” said Voller. “[Now] I get an injection once a month, and I don’t have to worry. I’m not saying I don’t have my bad days, but they’re much more manageable.”