Opioid dependence has grown immensely over the last decade, driven both by prescription and illicit use patterns.  In fact opioid dependence has become so problematic that it has been recently declared a public health emergency by the United States government.  Given the breadth of the opioid crisis, availability of treatment options have been rather limited in comparison to the magnitude of the epidemic.  Structured group and individual therapy, including Intensive Outpatient Programs (IOP) and traditional residential treatments remain the cornerstones of care.  Replacement protocols  such as Methadone, and Suboxone have provided benefit, particularly when combined with aforementioned therapeutic programming.   Naltrexone, a medication that blocks the activity of opioids, has also been of value.  A recent study published in JAMA Psychiatry looked at the effectiveness of the long acting injectable form of Naltrexone, trade name is Vivatrol, compared against buprenorphine-naloxone, trade name is Suboxone.

The study was structured as an outpatient, open-label randomized trial with a total of  159 participants.   Participants were randomly assigned to Suboxone or injectable Naltrexone. The study was short term, following the participants for a length of 12 weeks. Outcome measurements included study completion rate, opioid-negative days, number of days of illicit opioid use, and number of days of other illicit substance usage.  Of the 159 initial participants 105 of them completed the study.  Following completion and analysis of the date the investigative team concluded that extended-release naltrexone was as effective as buprenorphine-naloxone in maintaining short-term abstinence from heroin and other illicit substances and should be considered as a treatment option for opioid-dependent individuals.  The superiority data showed reduced rates of both heroin and illicit opioid use in the Naltrexone group in comparison with the Suboxone group. The results are encouraging as Naltrexone can be considered as a viable alternative to Suboxone for short term maintenance of opioid abstinence.