Extended-release naltrexone, which blocks the effects of opioid use, is being increasingly used by prisons in an effort to help prisoners with opioid use disorder stay off drugs once they have been released.
This story tracks that experimental use of the drug, marketed as Vivitrol by the Ireland-based pharmaceutical company Alkermes, and reflects the hope on the part of both prison officials and inmates that the drug will prove effective. However, the story also emphasizes that research on the drug’s effectiveness among prisoners has been scant, the cost of injections is high, and the company appears to be actively marketing the drug to prisons where, according to one source, an insufficient level of wariness about marketing tactics may enhance gullibility. One could argue that the preliminary nature of these efforts to test Vivitrol in a prison environment should lead journalists to delay stories until more evidence is in hand. But this story’s focus on cautionary aspects of the drug’s use and marketing does a nice job of illuminating the complexity of drug introductions.
There is currently a nationwide epidemic of opioid addiction and fatal overdose. A substantial proportion of the prison population is incarcerated in part because of opioid addiction and will be at risk again after their release. One of the periods of highest risk for fatal opioid overdose is immediately after release from incarceration. Available treatments, such as methadone and buprenorphine, reduce relapse but, since they are themselves opioids, are subject to abuse, making prison officials reluctant to use them, despite the evidence that these medications save lives. A drug that lacks the same abuse potential, if it were effective and affordable, would likely increase released inmates’ chances for a successful post-prison life, while being acceptable to prison officials.
The high cost of these regular injections is front and center in this story.
One randomized clinical study of Vivitrol was published recently in The New England Journal of Medicine, and this AP story gives it ample space. We’re told specifics like “After six months, the Vivitrol group had a lower rate of relapse, 43 percent compared with 64 percent.”
The experiment found no overdoses and fewer relapses in the Vivitrol group compared to individuals referred to a treatment program instead. However, within months of the study’s end, relapses among those in the Vivitrol group rose to the same level as that of the control group; the story makes that quite clear as well.
Although the story does make clear that evidence so far suggests that short-term use of Vivitrol does not eliminate overdoses in the longer term, it does not reflect on adverse events reported in the NEJM article as a result of the trial, which included such issues as reactions at the injection site, headaches and nausea.
The reader will gain some detailed information about one peer-reviewed study exploring the use of Vivitrol in a criminal-justice connected population. And although researchers involved in studying the drug reflect on it as a success story, the text brings home the argument that systematic evidence remains slim. Further, although the text offers one anecdotal success story, it also highlights the tale of a second opioid user who initially avoided relapsing through use of Vivitrol but then subsequently died from an overdose. Vivitrol has been approved for use by opioid users for six years; this story would have benefited from at least a brief evidentiary look at past research.
Opioid addiction is a major problem in American society and especially among the incarcerated, who are likely to relapse once released from prison.
The company that owns Vivitrol is clearly identified, as are a couple of sources who are studying the drug, including the first author of the NEJM study. At least one source, who expresses concern about the company’s vigorous marketing to prisons, appears to be independent. The National Institute on Drug Abuse, which supported the research discussed in the NEJM article, is also identified.
Existing alternatives, such as methodone and buprenorphine, are mentioned and their debits highlighted, but more could have been said about their track record.
Information about FDA approval of the drug—in 2006 for alcohol dependence and in 2010 for opioid users—is included in the story.
This is a trend story looking at the use of this drug among prison populations (and the recently incarcerated).
This appears to be an enterprise story, with as strong a focus on the cautionary aspects of Vivitrol’s use in prisons as on the drug’s potential benefits.