Title: Under Our Skin? New addiction treatments and the bias against patient choice

Daniel Wolfe, Roxanne Saucier

Setting: Recent years have seen approval or clinical testing of long-acting treatments for opioid dependence, including injectable naltrexone (Vivitrol), subdermal buprenorphine implants (Probuphine), and naltrexone implants in Russia (Prodetoxon) and Australia (the Go Medical implant). Injectable naltrexone has enjoyed particularly rapid market penetration, with US sales climbing to $47.2 million in the second quarter of 2016, and plans for expansion of treatment in other countries.

Key arguments: This presentation—using examples such as “Vivitrol courts” in the US, naltrexone implants in Russia, calls for naltrexone injection in Mauritius and other international examples—examines the implications of implants and long-acting injectables in addiction treatment. Key questions include the appeal of technologies that remove user ability to change dose or divert medicines to others, and recent surveys finding an abstinence bias underlying preference of criminal justice or public health systems for opioid antagonists that block intoxication over substances with psychotropic properties, even when the latter medications are more affordable, equally or more effective, and have a longer history of use. Connection is also made to debates around implantable contraception, frequently recommended in the name of patient effectiveness for young, ethnic/ minority women, another population frequently regarded as socially suspect.

Outcomes and implications: While significant attention has gone to the effects of drug control in limiting access to opioids for pain medication, drug control frameworks also shape research priorities and available treatments for addiction, particularly for implants and long-acting injectables. Analysis of market demand for these new medicines rarely distinguish—though harm reduction advocates must—between demand for those interested in regulating the behavior of people who use drugs and the interests of people who use drugs themselves.