Nidhi Prakash | April 21, 2015
An NYU Langone Medical Center study testing the use of a controversial heroin addiction treatment to prevent relapses in Rikers Island inmates has prompted concern from some advocates and analysts who worry that use of the drug could in some cases have fatal consequences.
The study examined the effectiveness of Vivitrol, or naltrexone—a drug already approved for use in the general population—in treating inmates who were about to be released. It involved 34 inmates, half of whom were given a combination of Vivitrol and counseling. The other half was given no treatment. After eight weeks, 88 percent of the inmates who received no treatment relapsed, compared to 38 percent of those given Vivitrol and counseling.
“We have a big big problem and we don’t really have a handle on it in terms of treatment or public health response. [It’s] a molecule that’s been in development since the 1970s. It’s just taken a long time,” said Joshua Lee, one of the lead researchers.
The concerns about the study stem from the idea that Vivitrol increases the potential for overdose because, unlike methadone or buprenorphine, it makes it impossible for a user to feel the effects of heroin, drastically lowering their tolerance. As a result, if addicts do relapse, they are more likely to take a dose of heroin their system cannot handle. If methadone or buprenorphine are used correctly, the person gets the same dose of the opioid-like drug at regular intervals, allowing them to function without giving them a high.
The study concludes, “Extended-release naltrexone is associated with significantly lower rates of opioid relapse among men in the United States following release from jail when compared with a no medication treatment-as-usual condition.”
Some analysts warned against drawing meaningful conclusions from the NYU Langone study because it is limited in its scope—with a small sample size and time frame.
“They made a declaration that Vivitrol is a viable treatment in the U.S. with men who are incarcerated and coming out of jail and I thought, wow, that is a huge statement for a small study where the difference between the two arms was not that great, although statistically significant,” said Holly Catania, an independent drug policy analyst, who has worked in the area of heroin relapse prevention since the late 90s.
“The politics is really that there are still a lot of people out there that are under this belief that methadone and bupernorphine are perpetuating drug use [and] that it’s somehow bad. But that’s certainly not backed up by medical evidence,” said Matt Curtis, policy director at advocacy group VOCAL NY, who said medications like Vivitrol could pose a threat to members of his organization—most of whom have been impacted by drug addiction in one way or another.
Curtis said that while researchers should be looking at all possible ways of combating heroin relapses, methadone and bupernorphine are proven and affordable treatments already available.