Combining Opiates and Vivitrol: What Will Happen?

opiates and vivitrolVivitrol is an opioid antagonist medication (naltrexone) that is designed to address cravings and abuse of opiate drugs and alcohol. Opiate antagonist drugs counteract the effects of opiate drugs and are often used to assist individuals who have opiate abuse problems or who have overdosed on opiate drugs.

Naltrexone should not be confused with the drug naloxone, a drug that is often used to reverse the effects of overdose on opiate drugs like heroin. Naltrexone is an opiate antagonist drug that does counter some of the effects of opiates, but it is most often used to reduce cravings in individuals who are trying to remain abstinent from opiate drugs. While it may reduce cravings, its use does not guarantee one will maintain abstinence, nor is using the drug a substitute for becoming involved in a substance use disorder treatment program.

Naltrexone also comes in pill form, and it’s probably better recognized by the trade name ReVia. Vivitrol is the extended-release version of naltrexone and administered via injection.

Naltrexone has very little abuse potential, and using it will not lead to physical dependence. The drug is not listed as a controlled substance by the United States Drug Enforcement Administration, and it can be legally obtained with a prescription from a physician. While the use of naltrexone products can assist individuals in recovery from opiate use disorders, there are some significant risks associated with its use.

Using Vivitrol to Assist in the Treatment of an Opiate Use Disorder

Opiate drugs include illicit drugs like heroin and prescription pain medications like OxyContin (oxycodone), Vicodin (acetaminophen and hydrocodone), morphine, codeine products, fentanyl, etc. Opiate drugs, also referred to as opioid or narcotic drugs, are significant drugs of abuse.

The use of naltrexone to assist in the treatment of opiate use disorders began in the 1980s. It has been formally approved by the Food and Drug Administration (FDA) for that use.

Naltrexone is often administered in pill form (ReVia), but empirical research evidence suggests that use of the pill form of the drug is often complicated by individuals not being compliant with using their medication. The use of Vivitrol may be more effective to assist in the treatment of opiate abuse and alcohol abuse because it is injectable and an extended-release version that does not require the person use it daily. However, it should be noted that a large review of the research regarding naltrexone’s utility in reducing cravings for opioids also suggested that it may be no more effective than a placebo.

The drug is not intended to be a standalone approach to the treatment of any substance use disorder. It should only be used in combination with a formal substance use disorder therapy program that includes an initial physician-assisted withdrawal management program (medical detox), therapy, and the implementation of a long-term aftercare program.

Risks Associated with Using Vivitrol and Opiate Drugs in Combination

According to the FDA, while Vivitrol is generally well tolerated in individuals, it should never be used by someone who is actively taking an opiate drug as this practice can significantly increase the potential that someone will suffer an opiate overdose.

  • Taking Vivitrol reduces the effects of opiates, leading to the potential to take more of the opiate drug than one can tolerate.
  • Using Vivitrol may be associated with a reduction in tolerance for opioids. After one has taken the drug and/or maintained abstinence from opiates, the person’s tolerance for opiates may have been significantly reduced, increasing the risk for overdose if they attempt to use amounts they were using prior to taking Vivitrol.

Opiate overdose is an extremely serious issue and can lead to significant organ or brain damage, and coma. It can even be fatal. Any person using any form of naltrexone including Vivitrol should not take opiate medications unless they have been prescribed by their physician and are closely monitored by that physician.

There are additional issues that can occur in individuals who use Vivitrol in conjunction with opiate drugs:

  • Some individuals develop reactions at the injection site, including severe tissue damage. This risk may be increased for people who previously injected other opiates.
  • The use of opiates in conjunction with Vivitrol, including opiate replacement medications such as Suboxone (buprenorphine and naloxone) or methadone, may result in sudden opiate withdrawal. It is suggested that a person is free from using opioid drugs for at least one to two weeks before starting Vivitrol to avoid this complication.
  • Vivitrol use may be associated with an increased risk to develop liver damage or hepatitis. Individuals who have hepatitis as a result of intravenous drug abuse may be at increased risk for severe liver damage.

Other potential side effects of naltrexone products include:

  • Gastrointestinal issues, such as abdominal cramps, nausea, and/or diarrhea
  • Muscle aches and muscle cramps
  • Headaches and dizziness
  • Anxiety and/or irritability

 Pregnant women should not use naltrexone products.

Vivitrol may be useful in decreasing cravings for opiate drugs in individuals who are in recovery from opioid use disorders, but there are significant risks associated with using Vivitrol and other opiates. In addition, Vivitrol is not an opiate replacement medication like Suboxone or methadone, and using it will not reduce withdrawal symptoms associated with recovery from an opioid use disorder.

Vivitrol use for controlling cravings from opiate drugs should occur in conjunction with being involved in a formal substance use disorder recovery program. Using any form of naltrexone is only recommended under the supervision of a physician and only once the individual has been abstinent from opiate drugs for a sufficient length of time to allow them to be fully eliminated from their system.