UCLA Addiction Reseacher Ling to Study Bup/Naltrexone Against Cocaine

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)