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Dr. Andrew Rynne

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Does Opiate usage after the first Vivitrol injection lead to dangerous health problems?

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Dr. Alexander H. Sheppe

Psychiatrist

Practicing since :2014

Answered : 2243 Questions

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Posted on Tue, 27 Oct 2015 in Smoking and Alcohol Addiction
Question: My question is in regards to receiving your second shot(or any subsequent shot) of Vivitrol during the 28-30 day window. For the initial shot it was imperative to not use any opiate and or Suboxone/Methadone 7-14days prior for fear of going in to severe precipitated withdrawals, my question is if any use occurs during the last 23-30days leading up to the next shot, will the shot cause the onset of precipitated withdrawals, or is the Vivitrol still present enough to smoothly transition in to the next 28-30 day cycle and continue blocking the receptors? I greatly appreciate any information you can provide regarding this matter and I thank you for your time.
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Answered by Dr. Alexander H. Sheppe 21 minutes later
Brief Answer:
Consultation

Detailed Answer:
Thanks for your question.

First, let me congratulate you on undertaking to overcome your addiction. This is a major accomplishment in itself.

As you note, opiates should be avoided prior to the first shot to avoid withdrawal. Opiate use after the first shot can be dangerous, because you are using more opiates to overcome the effect of the shot to produce a high, which can lead to overdose and death. I strongly advise against this.

When was your most recent use of opiates, and how much did you use? The medication is likely at steady state and the second injection will PROBABLY not cause withdrawal, but this is something you need to mention to your prescribing doctor as he or she may have variable levels of comfort with ongoing treatment, and while unlikely, if you were using heavily withdrawal is possible. If it were me, I would probably continue the shots, but I would step up other treatment modalities such as therapy and/or AA/NA and/or consider switching to suboxone or methadone as it appears Vivitrol is not enough for you by itself.

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Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Follow up: Dr. Alexander H. Sheppe 1 hour later
Thank you so much for the information you provided. I greatly appreciate it. The harm reduction that Vivitrol has allowed has been wonderful. It has absolutely helped with the craving aspect, and although I used hydrocodone on days 26 and 30 of the cycle, I felt little to no pleasurable effects. I think it was done merely out of curiosity, but today(day 31)I get my second Vivitrol shot, and I while I'm excited to continue treatment, I started to panic a little because there is no information out there including the Vivitrol website, that talks about any use that occurs in the last week of a cycle and precipitated withdrawals from any subsequent shot. I will definitely be forthright with my doctor, but I am hoping that he will say that although I might experience some minor withdrawals, because the Vivitrol is still present even at the tail end of the cycle, it should ease into the next without the severe precipitated withdrawals being brought on.
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Answered by Dr. Alexander H. Sheppe 55 minutes later
Brief Answer:
Follow up

Detailed Answer:
I'm a big believer in the harm reduction approach, and I'm glad it's working for you. I believe the continued use of Vivitrol for you far outweighs the risk of minor (if at all) withdrawal. The pharmacokinetics are such that the drug should still be at adequate levels in your system at this point. However, as you say, I recommend being up front with your doctor so you can decide together if your treatment approach needs any alterations. I'm personally interested in why you decided to use opiates again after abstaining for 26 days. I think examining that would be useful. But from a medical standpoint I think you should be okay.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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