New study from The Lancet finds naltrexone (Vivitrol) comparably effective as buprenorphine (Suboxone), providing more treatment options for patients. Providers should continue to consider all factors when considering which treatment to use.
There are a few different medication-assisted treatments available to help treat opioid addiction — old guards such as methadone and buprenorphine (Suboxone), and new comers such as naltrexone (Vivitrol). A recent study sought to compare the effectiveness of the old and new options, specifically naloxone and buprenorphine.
The results: both were similarly effective but factors such as the initial hurdles to starting the medications, the way they work, costs, and treatment processes should be considered when deciding which treatment to use for a patient.
For the first time, a new study in The Lancet, sponsored by the National Institute on Drug Abuse (NIDA), compared the effectiveness of naltrexone with buprenorphine. The results were both promising and disappointing. While naltrexone is as effective as buprenorphine once treatment begins, it is also significantly more difficult to actually start naltrexone because it requires an extensive detox period — which can span more than a week — that buprenorphine does not.
The good news, though, is that buprenorphine and naltrexone were similarly effective once patients got over the initial hurdle. For naltrexone, the opioid relapse rate was about 52 percent. For buprenorphine, it was 56 percent. These were statistically similar, with no difference between men and women. Other measures, such as opioid-negative urine samples, opioid-abstinent days, and overdoses, did not differ between naltrexone and buprenorphine.
The Vox article explains in detail how the report showed that while both medications are ultimately effective in treating opioid addiction, there are differences between the two medications that factor into how good a fit each would be as an option for a particular individual.
It concluded that multiple treatment paths and treatment options are needed to ensure patient’s needs and treatments are effectively being met. For the right patient Naltreoxone is as effective as the medication-assisted treatment options.
Different options are needed. As Humphreys told me, “In the rest of medicine, we accept that there are multiple treatment paths and that patient preference matters.” The same should be true for addiction. After all, even though buprenorphine is still considered the gold standard for addiction care, the Lancet study found it still had an average relapse rate above 50 percent. It’s clear that buprenorphine doesn’t serve all patients and that other options are needed.
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