The United States is suffering through an unprecedented wave of opioid and prescription drug abuse. An estimated 2.5 million people are addicted to prescription opioids or heroin, and on average 91 people per day die from an opioid-related overdose.
A new study comparing two of the top medications for treating addiction found they were equally safe and effective in curtailing opioid use, relapse, treatment dropout and overdose.
The most commonly prescribed treatment is buprenorphine-naloxone, often administered to treat a narcotic overdose in an emergency situation. The problem is that it has opioid-like effects and holds the potential for abuse.
In contrast, the drug naltrexone — marketed as Vivitrol — blocks the effects of opioids. But patients must be completely off opiates to start taking it.
Joshua Lee, at New York University’s School of Medicine, said the two drugs are used in very different ways.
"Naltrexone is an opioid blocker, and so it's used after people have gotten off opiates ... and then want to maintain in an opiate-free state, using naltrexone to help them," he said. "Buprenorphine is used in more of a maintenance model where people switch without fully detoxing from a unhealthy opioid — say, heroin — to buprenorphine, which can be taken on a daily basis and then maintained for months and months in terms of long-term recovery."
Lee and his colleagues led a study to compare the two therapies.
A group of 570 opioid-dependent adults who were still trying to kick their heroin habits in detox were given either a daily oral dose of buprenorphine while in treatment, or six monthly injections of naltrexone after completing treatment. Results showed that both therapies worked with about the same effectiveness.
"Over the course of six months, about the same amount of people that had started did OK in terms of avoiding opiate relapse and kind of surviving on treatment, doing reasonably well in terms of traditional outpatient opiate treatment goals," Lee said.
One caveat: Twenty-five percent of the people scheduled to take naltrexone weren't able to complete detoxification, so they weren't able to get the shots, while only 6 percent of members in the other study group were unable to start their daily doses of buprenorphine.
The researchers hope their finding that the medications were equally safe and effective encourages clinics to expand their treatment offerings — and save lives.