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UCLA Addiction Reseacher Ling to Study Bup/Naltrexone Against Cocaine | Print |  E-mail
Addiction Treatment Industry Newswire

08/11/2012 - ATIN-  Renowned UCLA addiction researcher Walter Ling, pictured right, has been asked by NIDA to lead a human trial study to determine the effectiveness of a compound of buprenorphine and naltrexone in treating cocaine addiction. If successful, it is thought that the combination would likely also prove effective against other stimulants such as methamphetamine, considered a particularly difficult and intractable drug from which to recover. Buprenorphine, among the most studied and researched drugs in history, has shown to have a multitude of potential uses, having been known to be effective, for example, in relieving depression. For now, buprenorphine is mostly employed in the famous Suboxone, which is widely used to treat opiate addiction, either in step down detox dosing for short term use or as a maintenance opiate replacement therapy in long term use. The drug has been a huge bestseller for Reckitt Benckiser, a British company known mostly for making household products, selling over $250M in prescriptions annually in the U.S. alone. Suboxone, which can cost thousands of dollars a year depending on dose, has emerged as a major competitive threat to the methadone clinic and will become even more so when it goes generic, which consumers and doctors are eagerly awaiting but which Reckitt Benckiser, as drug companies often do with major sellers, has been resisting.

Significant Advance

According to Scripps Research Institute, which did prior buprenorphine/naltrexone studies, the work that Ling is doing could represent a significant advance in the field "because there are currently no FDA-approved medications for treating cocaine addiction." If successful, the human tests could provide a basis for Reckitt Benckiser to get more mileage out of its buprenorphine franchise, perhaps rejigging Subxone, getting another patent and going after a whole new market of cocaine abusers. Such a strategy on the part of drug makers is often referred to by industry critics as "old wine in a new bottle" and can significantly lengthen the period of high profits, and high cost for insurers and consumers, on a given drug or pharmacological approach. A combination buprenorphine/naltrexone drug, however, would be significantly different than Suboxone, which is a combination of buprenorphine and naloxone, an anti opiate abuse agent.

"Old Wine in a New Bottle"

VIVITROL is hugely expensive, $1,100 per month vs generic $50 to $100, and as been severely criticsed as not worth the extra expense by many doctorsA more classic old wine in new bottle drug, critics say, is VIVITROL, the anti-craving medication from Boston-based Alkermes that is the only drug outside of opiate maintenance drugs ever to be specifically developed and approved to treat addiction. The pharmacological therapy, which was initially list priced at a staggering $7,000 per treatment, is a monthly injection of long generic naltrexone, the same drug Ling is testing in combination with buprenorphine. In discussions with Treatment Magazine prescribing doctors have long expressed bewilderment at VIVITROL's enormous cost, pointing out that a monthly dose of naltrexone taken orally, which would have the exact same therapeutic impact as the VIVITROL injection, cost only around $50 to $100. (In an email response to this article, Alkermes says the VIVITROL cost is currently $1,100 per treatment, which is only 10 times to 20 times the cost of generic. compared to the stratospheric 75 times to 150 times generic Alkermes sought when it introduced VIVITROL)  Alkermes, which specializes in "delivery" mechanisms for drugs and whose best seller is a one dose per month Risperdal-Consta for schizophrenics, says that the injection delivery system it added to naltrexone to create VIVITROL is valuable because with just one injection patients don't have to bother with daily dosing and doctors are assured the patient is compliant with the medication regimen.

Risperdal Vs VIVITROL

However, there is a major difference between risperdal for schizophrenics and naltrexone for addicts in that risperdal is absolutely critical for schizophrenics to take and is a "cure" in the sense that a patient can be totally psychotic one minute and take risperdal and be high functioning within a short period of time. With naltrexone there is not even remotely this type of miraculous effect on the symptoms of addiction and the drug works on the margins to reduce craving. In a nutshell, if a patient misses their daily dosing of risperdal it can make all the difference in the world, while if an addict misses their naltrexone the difference is barely noticeable and extremely difficult to measure, thus making $1,100 a month - vs $50 to $100 generic - a highly dubious expenditure. "It's spending like this that is bankrupting our medical system," asserted one particularly disgusted addiction doc when asked about VIVITROL's high cost.

(Editor's Note: Treatment Magazine has for months been trying to communicate with top executives and communications/marketing personnel from Alkermes and getting no response. Therefore we did not attempt to communicate with them as we wrote this story, which was prompted by the news of the Dr. Ling study. Following publication of the story, we heard from Alkermes and their comments about the current pricing of VIVITROL are included above)

 

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written by Kathy gordon, August 16, 2012
Part 2 of interview by Dr. Frank McGeorge WDIV:

http://www.clickondetroit.com/lifestyle/health/Local-student-shares-how-she-got-clean-from-heroin/-/2300442/15752712/-/rmlhhiz/-/index.html
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written by Kathy gordon, August 16, 2012
Part 1 of interview by Dr. Frank McGeorge WDIV:

http://www.clickondetroit.com/lifestyle/health/How-good-student-became-heroin-addict/-/2300442/15736654/-/2e15u5/-/index.html
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written by Kathy gordon, August 16, 2012
Here's a treatment that actually works. I know because this beautiful young lady is my daughter.

http://www.freep.com/article/20120708/FEATURES08/207080589/Revolutionary-new-drug-Vivitrol-offers-new-life-to-addicts
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Founder: Neuroscience and Addiction Research Foundation, New Concept and Associates
written by Dan Gray, August 13, 2012
The idea is sound neurobiologically. As I see it there are neuronutritional aids that must be taken into consideration to gain the most favorable results. Also, a look at the genetic/epigenetic factors that may skew the results might be a good idea.
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written by Kathy, August 13, 2012
Seriously? As the mother of a former heroin addict let me make it perfectly clear that being free of the cravings of addiction is no less of a 'cure' than a schizophrenic being 'cured' by their medication. In the bowels of addiction, being expected to remember to take your daily Naltrexone pill is no less difficult than remembering to eat or bathe.

As far as the cost, Vivitrol is covered by most private insurance and Medicaid. Compare the $1,100 a month to a single week of inpatient rehab (which is often repeated over and over again ( in my daughter's case 9 times to no avail), then that $1,100 sure looks like money well spent. If it wasn’t cost effective, private insurance wouldn’t cover it. How about just putting them in jail? Surly being incarcerated costs less than $1,100 a month… Wrong again.

Vivitrol saved my daughter's life. It accomplished what no other treatment was able to do. She was in rehab 9 times, was put on Suboxone only to sell it when she found out that it was just as addicting as heroin and has even worse withdrawals. She tried methadone too... the ONLY thing that helped her was getting that shot in her fanny. Not only did it make using drugs a non-issue since they would have no effect, in her case if totally and completely stopped ALL cravings. Also, unlike methadone and Suboxone, it is NOT addicting. No trading one addiction for another, no weaning down in doses and no selling it so no turning it into another illegal/legal street drug.

If you are addicted to caffeine, think how bad your head hurts when you don't get that cup of joe in the morning. What about nicotine? Irritable and jittery when you run out of smokes? What if you didn't feel those effects? What if there wasn't a little voice in your head telling you to make a cup of coffee or grab a pack of smokes? That is what Vivitrol (or more specifically, the Naltrexone in the Vivitrol shot) does for opiate cravings.

How dare you pat Alkermes on the head for making an injectable medication for schizophrenics then smack them across the face for doing the same for opiate addicts. Unless you have lived or loved an addict and seen for yourself the difference Vivitrol makes in an addict you have nothing to base your statements on.

"barely noticeable and extremely difficult to measure" my foot. You obviously have not spoken to the recovering addicts that have benefited from their monthly shot or their grateful families. Try it. Before you spew gibberish, try talking to patients and their families. Ask US if we think our child’s life is worth $1,100 a month. I’ll even go you one better… Vivitrol, unlike the medication for schizophrenia is only needed for a short time; from what I have read and been told, 6 to 12 months is the recommended treatment period. A person addicted to opiates is in the process of dying; no less than a person with cancer is dying. Six to 12 months is $6,600 to $13,200 to save a life, to restore sanity to an entire family. For my money, to be able to see my daughter not only existing, but thriving… the answer is obvious.

Just out of curiosity, what type of treatment does your, “particularly disgusted addiction doc” use with his patients? What is his success rate? How much money is he making of his patients going through the revolving door multiple times? Sorry Ted but I’ve been there, done that and know that the current, established treatment options just don’t work for the majority of addicts. My daughter has lost 3; count them 3 friends to their addiction in the past year. Every life, even that of a heroin addict has worth, and for you to say that an addict’s life isn’t worth $13K… well, shame on you.
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Mother of a former addict
written by Kathy, August 13, 2012
Seriously? As the mother of a former heroin addict let me make it perfectly clear that being free of the cravings of addiction is no less of a 'cure' than a schizophrenic being 'cured' by their medication. In the bowels of addiction, being expected to remember to take your daily Naltrexone pill is no less difficult than remembering to eat or bathe.

As far as the cost, Vivitrol is covered by most private insurance and Medicaid. Compare the $1,100 a month to a single week of inpatient rehab (which is often repeated over and over again ( in my daughter's case 9 times to no avail), then that $1,100 sure looks like money well spent. If it wasn’t cost effective, private insurance wouldn’t cover it. How about just putting them in jail? Surly being incarcerated costs less than $1,100 a month… Wrong again.

Vivitrol saved my daughter's life. It accomplished what no other treatment was able to do. She was in rehab 9 times, was put on Suboxone only to sell it when she found out that it was just as addicting as heroin and has even worse withdrawals. She tried methadone too... the ONLY thing that helped her was getting that shot in her fanny. Not only did it make using drugs a non-issue since they would have no effect, in her case if totally and completely stopped ALL cravings. Also, unlike methadone and Suboxone, it is NOT addicting. No trading one addiction for another, no weaning down in doses and no selling it so no turning it into another illegal/legal street drug.

If you are addicted to caffeine, think how bad your head hurts when you don't get that cup of joe in the morning. What about nicotine? Irritable and jittery when you run out of smokes? What if you didn't feel those effects? What if there wasn't a little voice in your head telling you to make a cup of coffee or grab a pack of smokes? That is what Vivitrol (or more specifically, the Naltrexone in the Vivitrol shot) does for opiate cravings.

How dare you pat Alkermes on the head for making an injectable medication for schizophrenics then smack them across the face for doing the same for opiate addicts. Unless you have lived or loved an addict and seen for yourself the difference Vivitrol makes in an addict you have nothing to base your statements on.

"barely noticeable and extremely difficult to measure" my foot. You obviously have not spoken to the recovering addicts that have benefited from their monthly shot or their grateful families. Try it. Before you spew gibberish, try talking to patients and their families. Ask US if we think our child’s life is worth $1,100 a month. I’ll even go you one better… Vivitrol, unlike the medication for schizophrenia is only needed for a short time; from what I have read and been told, 6 to 12 months is the recommended treatment period. A person addicted to opiates is in the process of dying; no less than a person with cancer is dying. Six to 12 months is $6,600 to $13,200 to save a life, to restore sanity to an entire family. For my money, to be able to see my daughter not only existing, but thriving… the answer is obvious.

Just out of curiosity, what type of treatment does your, “particularly disgusted addiction doc” use with his patients? What is his success rate? How much money is he making of his patients going through the revolving door multiple times? Sorry Ted but I’ve been there, done that and know that the current, established treatment options just don’t work for the majority of addicts. My daughter has lost 3; count them 3 friends to their addiction in the past year. Every life, even that of a heroin addict has worth, and for you to say that an addict’s life isn’t worth $13K… well, shame on you.
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written by Scott, August 13, 2012
How does this combination work. It seems contradictory biochemically. Also is the plan to give a narcotic to people who are cocaine abusers only?
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written by Karen Jones, August 13, 2012
Ok. This is the second time I'm trying to leave a comment. I can tell you first hand that Vivitrol has been like a cure for me. I call it my miracle. After having tried Suboxone and methadone many times - and relapsed - I found about about Vivitrol and my life has never been the same. I have my life back. And, I certainly didn't pay $7,000. Where did you get that number? In fact my insurance pays and I think it's only $1,000 which to me is short change considering how much I spent on rehabs and not to mention buying drugs. It takes away my cravings and I don't know what I'd do without it. I've been on it for a year and have no plans to stop. And there is a big difference with the pills. Not having to decide everyday to take a pill is a huge factor, at least for me. Please don't discourage people from trying this option. It could save their life.
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Drug and alcohol counselor, San Diego, California
written by Karen Jones, August 13, 2012
Wow. I'm really surprised to read such a bias article about Vivitrol. I can say first hand that this medicine saved my life and has been a "cure" for me. Having tried Suboxone and methadone - and relapsed - more than 10 times - I consider Vivitrol to be a miracle. It completely takes away my cravings and I have no desire to use (even to drink alcohol for that matter). It changed my life so much that I went to school to become a substance abuse counselor and help others. And, I have NO idea where the $7,000 number comes from. My insurance covers most of it and the company that makes Vivitrol gives co-pay help. And when we bill patients at my clinic, it costs $1,000. To me that is well worth the price, given how much I spent on rehabs. Where did you ever hear $7,000? Do you mean for the entire year? And I should mention that we've found that those who get naltrexone really do have trouble complying with treatment, so a once/month shot is so key. This medicine saved my life. Please don't discourage others from trying it.
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