2 New Ways to Kick Heroin: A High-Blocking Injection, a Long-Lasting Implant

By Jennifer Welsh | October 15, 2010 12:51 pm

heroinTwo new long-lasting options for treating opioid abuse could help heroin addicts avoid relapses.

The new drugs solve a problem with the current treatments for opioid addiction. These drugs, called methadone and buprenorphine, are really just replacement addictions, and their use needs to be closely monitored; patients take them daily at a clinic, because they can be abused by crushing up the pills and injecting them.

The first drug, which was just approved by the FDA, is called Vivitrol: The drug works by blocking the effect of opiates on brain cells, preventing the person from getting high. The effects of one injection last for a full month. In a clinical trial in Russia, 86 percent of people taking Vivitrol hadn’t relapsed after six months, while only 57 percent of placebo patients had stayed clean. However, researchers note that methadone isn’t available in Russia, and say it might be harder to convince addicts in the United States to opt for this treatment.

Vivitrol’s long-acting effect provides a kind of chemical willpower. “Someone who’s interested in not abusing opiates only has to make one good decision a month –- or their family member only has to help them make one good decision a month,”[Phil] Skolnick [of the National Institute on Drug Abuse] says. “That’s why it’s important.” [NPR].

The drug’s active ingredient, naltrexone, has been available to treat opioid addiction since the 1970s. To make this long-lasting Vivitrol, the non-addictive drug is encapsulated in tiny polymer bubbles, which break down over time and release the drug. Since it doesn’t provide a high like methadone or buprenorphine do, naltrexone researcher Charles O’Brien says its appeal may be limited.

Still, Vivitrol should be useful, O’Brien says, for “people who have been in a hospital and have become drug-free, people who are well-educated and have private health insurance.” In other words, people who are strongly motivated to end their opiate addiction. [NPR].

For those who want to stick with the opiates they know and love, the second new treatment could be a good fit. The implant releases the semi-synthetic opioid buprenorphine, which is commonly used to treat addiction–but it dribbles out the medication over a time frame of six months, instead of requiring the patient to take daily doses. Says addiction researcher Linda Gowing:

“The use of implants provides a degree of flexibility for clients, while also maintaining medication with minimal risk of misuse.” [Science News]

The drug is mixed with a plastic polymer, ethylene vinyl acetate–commonly found in hot glue gun glue–and is implanted under the skin, releasing the drug for 24 weeks. The implant is not on the market yet, but the results of a clinical trial were released this week in the Journal of American Medical Association.

The implant was tested on a group of opiate dependents. Two-thirds of the people who received the implant finished the trial, compared to less than a third of those with placebo implants. And the piss tests came back cleaner too–37 percent of those on the implant never tested positive for illicit drugs, compared to 22 percent of those with the placebo.

The company behind the implant, Titan Pharmaceuticals, is currently conducting a second trial of the drug, and the results should be out in early 2011. One worry about these long-lasting drugs is that patients who don’t have to come in and take their medication will be less likely to attend counseling sessions regularly, and therefore be more likely to relapse. Says addiction researcher Douglas Bruce:

“Most people become drug users because of sexual trauma as kids or other violence. Bad things happen to people, and drugs make them feel better.” To break the addiction cycle, Bruce says, medication must be complemented with counseling. “They will always have to take the meds if they never deal with the root issue.” [Science News].

Related content:
80beats: To Help Heroin Addicts, Give Them… Prescription Heroin?
The Intersection: The Politics of Addiction
Discoblog: New Especially Bad Heroin Can Give You an Overdose—or Anthrax
DISCOVER: The Biology of . . . Addiction
DISCOVER: Can an Injection Break a Cocaine Addiction?
DISCOVER: Molecular Psychiatrist Eric Nestler It’s a Hard Habit to Break

Image: Flickr/CrashTestAddict

CATEGORIZED UNDER: Health & Medicine
  • http://Untitledvanityproject.blogspot.com Rhacodactylus

    This is awesome! Addiction science is such an odd field, it’s so hard to find evidence based approaches, if one more person tells me to accept a higher power I’m knocking over the table with all the coffee and donuts on it =)

    ~Rhaco

  • Jim

    It’s really good that they found somethnig that works very well against drug addiction. One small thing surprised me though, they said, “And the piss tests came back cleaner too–37 percent of those on the implant never tested positive for illicit drugs, compared to 22 percent of those with the placebo.” I was very surprised they said “piss” instead of urine, made me chuckle.

  • Dode

    LOL funny, I zeroed in on the Piss comment too, I work in the oil field, and guys get “piss-tested” all the time. I substituted “urine analysis” for you guys in order to maintain the scientific intellectual no- B.S. facts – and the world didn’t explode!!!

  • http://www.methadone.org MARS Director

    Many of the comments in this so called scientific article are just repeating the same old nonsense that has no evidence to support it including: “Most people become drug users because of sexual trauma as kids or other violence.”some perhaps but to say most you need evidence, and my favorite comment from the non biased researcher ….”For those who want to stick with the opiates they know and love,” .
    I don’t know how to repond to someone who thinks treatment with agonist medications is effective because patients “know and love” them. If “DISCOVER” is going to pretend to be more then the “same old same old you will have to make a little better effort to conceal your bias.

  • Patti Wilson-Herndon

    “Most people become drug users because of sexual trauma as kids or other violence.”

    Oh dear…”Most” people ? Wow. This, folks, is a good example of how an “addiction expert” can undermine the credibility and merit of the field of addictions study, as well as discrediting the reputations of other “experts” in research. Nice going, Bruce. Ever heard of “stigma”?

    Mr. Bruce? Next time you have the opportunity to do some good in educating the public about these Medical Assisted Treatment (MATS) developments in the field of addictions study, I suggest you remember this particular gaffe in excrementitious ineptitude. You’re NOT helping a whole lot, here.

    The good news, Folks: The rest of that quote was meritable. So, let’s focus on the better accurate attributes of his offering, shall we? ” To break the addiction cycle, Bruce says, medication must be complemented with counseling. “They will always have to take the meds if they never deal with the root issue.” Good boy, Bruce ;0)

    The majority of contemporary addictions professionals tend toward viewing substance use disorders as a collective result of biological (i.e., genetic, biochemical) and environmental (i.e., family systems and community/societal dynamics) dysfunction. Think “biology/gene-related component as the gun, the environmental component (ailing family system/societal stigmas) as the trigger”. So…. what Bruce inferred, about “counseling” being an intregal piece in the puzzle in terms of addressing the whole picture”, is on target.

    If you’re a parent of an addiction challenged son or daughter ….move heaven and earth to to stay current in terms of your own education as to available treatments. Don’t put limits on the “recovery discovery” potential of your loved who is addiction-challenged by prescribing only to 12 steps, or “prayer” as a the end all be all; BECAUSE: One size does not fit all. This is especially true of addiction recovery. Promote self-efficacy by encouraging your family member to explore treatment options.

    It’s the addicted individuals’ responsibility to do the problem-solving leg work. If you’re the family member it’s your role to support lovingly, responsibly what it is that will result in enhanced coping for your addiction-challenged family member. Harm reduction is valid. Remember it’s not about you…Yes, i get it, their addiction impacts you. That’s life. We don’t pick and choose these things. Ultimately, it’s about helping the addicted individual cope better and better, little by little, utilizing any and all methods available. Family and community support is a critical component in that coping potential. psychotherapeutic, cognitive behavioral and motivational therapies activate good coping mechanisms for many, many substance disordered individuals, even those with the most severe symptoms.

    I’m hopeful that vivitrol and other types of MATS will prove effective, long term. I’m grateful for the people that work so hard to unravel the mysteries of the brain. Keep up the good work addictions researchers…but mind your tongues, too. Informed people know BS when they read it . Some poop is to be expected…but, when the crap contaminates, otherwise, good information about the biopsychosocial reality of addiction; there will, usually, be a whistle blower at the ready to cover up the pile so the focus remains excrement-free.

  • http://- Phil Doran

    Naltrexone is also used as a last resort for parrots that persistently pluck their own feathers, and cannot be cured by different management.
    It blocks the effects of endorphins.

    But leave it to your vet to work out the correct dose.

  • MensaJeff

    It is, in fact, a urine analysis…among people with a respect for society and civilization. Adults, let’s say.
    And yes, the statement, “Most people become drug users because of sexual trauma as kids or other violence” is laughable without backup data, and I’ll bet there aren’t any.

    But the big disappointment is that I never expected to find such a smart-alecky tone in your magazine. It displays a lack of professionalism, and undermines the truth and authority of your voice. And the author’s flippant remarks betray an opinion of the subject matter, and the people involved, that does not belong in the article.
    To your credit, this article is almost shockingly out of place.
    There’s nothing wrong with trying to lighten otherwise dry and technical reporting of facts, which is the bulk of what you do, but that doesn’t mean that any and all subjects are good candidates for it.
    Disappointing.

  • http://blogs.discovermagazine.com/80beats/ Eliza Strickland

    It’s a blog post, y’all, not a scholarly article in a medical journal. I’m a fan of Jen’s lively writing.

    — Eliza, DISCOVER online news editor

  • Hans Bottesch

    I was hoping to see some mention of the use of the drug IBOGAINE to treat drug addiction. Presumably, this drug, derived from the African Iboga plant, offers long-lasting, if not permanent relief from the urge to relapse into opiate addiction. Treatment is currently available in Europe, Cancda and Mexico, and is expensive ($5k) according to what I have read. Successful treatment ranges from good to miraculous. If this is true, we should already be focused on studying and developing this drug for use here in the U.S. You can look it up on the web. The immense societal problems caused by the proliferation of the abuse of opiates should be reason enough for us to look at IBOGAINE as a potential means to address and reverse this alarming trend. Otherwise, we will eventually go the way of China during the Opium Wars. My youngest son is a Heroin addict and is currently serving 7-20 years for the addiction-driven crimes of burglary which he committed.

  • Patti Wilson-Herndon

    Thanks, Hans, for this info. on IBOGAINE. And, best wishes for health and well-being to you and your son. I can’t help but imagine that your son has been, and is, fortunate, (even in the circumstances he faces), to have you as a parent.

    “The immense societal problems caused by the proliferation of the abuse of opiates should be reason enough for us to look at IBOGAINE as a potential means to address and reverse this alarming trend.”

    You’re so right… I believe potential society-healing “helps/supports” for substance dependent individuals should be considered, investigated and offered to the public to learn more about. You just helped that process along.

  • Dean

    Being an ex “addiction-challenged” person (i did lol ..addict would have done well enough)
    I had treatment with both methadone and buprenorphine . Buprenorphine the first time then what i found the more beneficial methadone. Thankfully i have now been clean for over 4 years and can safely say, i will never go back to using heroin due to the care and insight i was given by ex addicts in the drop in center i visited .
    Use of language is highly important when dealing with people in this situation, a down to earth approach will get you everywhere with them. No amount of fancy wording or the belief that “Most people become drug users because of sexual trauma as kids or other violence” can help you or the patient. For me it was as simple as Tried it, liked it, kept doing it until it was to late to stop without treatment.
    During my time at the center i did become aware that some people try to abuse the help and use it as a “free hit” it is a fact that some people” want to stick with the opiates they know and love” it is sad, but some people just cannot be helped.
    ” Piss testing” (this is the technical term in the trade) was also a very important part of my rehabilitation. Test positive and your out of the game, this happed to me once and it gave me the time to think about how good life can be when your illicit drug free.
    Hard but fair will win the battle. ;)

  • Patti Wilson-Herndon

    Dean,

    Sincere congratulations on your four years of sustained recovery.

    “Sustained recovery”. -Aiming for what I hope for you will be another LOL-able moment in your addiction journey. Hey…Whatever gets your giggle on. No judgment…I’m just sayin’ ;0)

    It occurs that perhaps a de-fancified approach of “Congrats on four years of clean “piss testing” might suit you better ;0) “Down to earth” , very “trade”-recognizable “technical” terminology ;0)

  • http://www.pressingtheissue.com PressingThe Issue

    I’ve been in a Suboxone outpatient treatment program for awhile now and it has changed my life! I’m almost done with my treatment and am getting a little nervous.. I think that I’m gonna get on vivitrol to add a little extra protection as well as continuing one on one and group therapy. Please click on PressingTheIssue above this post to get more information regarding getting help for heroin addiction.

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