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CNN is clear on the comparative benefits of two drugs for opioid use disorder

Rating

3 Star

Categories

Some opioid addiction drugs harder to start than others, study finds

Our Review Summary

Stemming disability and deaths from opioid use disorder is a major public health challenge, and medication has become the treatment of choice to help people with addiction. The study reported in this CNN story compares two available drugs—buprenorphine/naloxone (Suboxone) and naltrexone (Vivitrol)—that can blunt or block cravings and reduce illicit opioid use.

The clinical study found that people with opioid use disorder were far more likely to begin taking one (Suboxone) than the other (Vivitrol), principally because Vivitrol requires patients to have first gone through detoxification. That’s an important difference, the article notes, as effectiveness is more likely if a physician can choose a drug that fits her patient’s circumstances. The story does a nice job of making this point, although it gives less attention to another sobering pattern unearthed by the study: Among the subjects who started the drugs, fewer than half were still taking them six months later. Also, more needed to be said about the potential harms of the medications–both carry risks–as well as their general availability and cost.

We wanted to point out two things with the story that don’t fall within the realm of our review criteria:

  1. The story states if you are on Vivitrol and take an opioid, you experience withdrawal—this is incorrect. Instead, “if a person relapses and uses the problem drug, naltrexone prevents the feeling of getting high,” as SAMHSA explains.
  2. The story ran a picture of naloxone (brand name Narcan) with a link to a different story. This picture may confuse readers. Narcan alone is used in emergency overdose settings–not as part of treating opioid use disorder/addiction treatment. However, it is also a component chemical in Suboxone.

 

Why This Matters

We know that opioid agonist treatments (Suboxone and methadone) are the current gold standard for treatment of opioid use disorder. However, riding on a wave of marketing and lobbying, injectable Vivitrol has become a commonly prescribed medication for this disorder. Vivitrol does not induce physical dependence, as does methadone or Suboxone, so it is attractive to people and policymakers who dislike the notion of medications that are difficult to stop taking. This study is the first to address whether Vivitrol is as effective as Suboxone in a head-to-head randomized trial. Having a third medication that acts via a different mechanism than the other two would be an important addition to the arsenal.

For readers coping with opioid use disorder in their lives, this story will help them understand important differences between the two drugs, at least in terms of starting treatment.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Cost does not make an appearance. This is a problem for a comparative story, as the prices for these two drugs seem quite different, with Vivitrol looking by far the more expensive.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story describes duration of staying on the treatments and rates of relapse, reporting that the rates are roughly equal. The story is also clear that that those randomized to Vivitrol did not do nearly as well as those randomized to Suboxone–because over a quarter did not tolerate or receive the first dose of Vivitrol. If a person is hardy enough to tolerate detoxing in preparation for Vivitrol, then their likelihood of abstaining from opioids may be similar to those getting Suboxone (a little less than half of all people in the trial were still taking the drugs after six months).

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

Both Vivitrol and Suboxone have side effects that are not compared—or even mentioned—in this story.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story offers some methodological detail about the clinical study, although we cannot tell if individuals were randomly assigned to conditions (they were), if the study was blinded (it was not). Also readers should have been informed of the major limitations of the study.

One interesting thing to note: The study did not look at how many of the subjects used the very potent drug fentanyl, which is involved in over half of overdose fatalities currently.

Does the story commit disease-mongering?

Satisfactory

CDC death estimates from opioid overdose in the United States are included, and the story did not disease monger the problem.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

Although the sources are clearly identified, funding information is missing in action, as are any references to possible conflicts of interest. For example, lead author Dr. Joshua Lee has accepted grant money from Alkermes, the manufacturer of Vivitrol. This should have been disclosed.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story compares two treatment drugs, as well as methadone. That’s sufficient, although non-medication-assisted alternatives were not discussed.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

All three drugs mentioned in the story are available, though more could have been said about how accessible they are to people who are trying to overcome addiction.

Does the story establish the true novelty of the approach?

Satisfactory

The lead touts the study as “the first large head-to-head comparison of two opioid treatment drugs.”

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story includes reporting that’s independent from The Lancet’s news release. It is interesting to see the different framing of the study from the drug company that makes Vivitrol.

Total Score: 6 of 10 Satisfactory

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