Vivitrol

Vivitrol is a monthly naltrexone injection that blocks opioids and reduces cravings, occupying a distinct place in the book’s account of addiction treatment: unlike opioid-based maintenance medicines, it has no abuse potential or street value. That distinction made it appealing to law enforcement, but the experiences of Joey Gilbert and her family show that a medication’s clinical promise did not ensure continuous access. Insurance coverage, cost, waiting lists, and treatment-center rules shaped whether it could be used at the moment it might help.

Definition and treatment role

Naltrexone was approved to treat opioid and alcohol addiction in 1984, but it was slow to gain acceptance among doctors and people with addiction. The injectable form, Vivitrol, lasts about a month and combines opioid blockade with an anticraving effect. Because it cannot be abused or diverted for street use, it later became the favored form of medication-assisted treatment among law-enforcement officials.

The book sets Vivitrol against the wider controversy over treating opioid addiction with medication. Buprenorphine and methadone can reduce withdrawal and cravings, but their status as opioids has made them contentious in some treatment and criminal-justice settings. Vivitrol’s non-opioid action offered a different answer to that suspicion, though its distinct appeal did not remove the practical obstacles to treatment.

Acceptance and institutional use

Despite an early researcher’s view that naltrexone was a pharmacologically ideal solution, its use remained limited for years. It gained wider visibility when its maker began marketing the injection aggressively to drug courts and jails around 2012. In some states that had expanded Medicaid, access improved enough for people to receive Vivitrol before release from prison or jail. The timing mattered: after a period without using opioids, people’s tolerance could be low, leaving them especially vulnerable to overdose if they returned to use.

That institutional preference did not mean Vivitrol was readily available to everyone. The book presents it as one possible component in a fragmented treatment system, where coverage and eligibility could determine whether a person continued one medication, changed to another, or entered a program that permitted no medication at all.

Joey Gilbert’s interrupted access

Joey Gilbert had earlier done well on the monthly injection, but lost access when she turned twenty-six and was no longer covered by her father’s insurance. Her father, Danny Gilbert, said that without insurance the medication would have cost the family $1,500 a month. Joey later moved to buprenorphine, prescribed by David Hartman, a psychiatrist whose federally mandated waiting list had also delayed access for Tess Henry. Hartman required Joey to pass weekly drug tests, while Danny kept and dispensed her medication; the monthly cost was about $700.

Vivitrol returned to Joey’s treatment options during a later period of sobriety. Jamie Waldrop and Cheri Hartman worked together to find her a residential-treatment bed, and Cheri persuaded her psychiatrist husband, David Hartman, to take Joey on again as a Suboxone patient. Joey’s divorced parents shared the costs of medication, appointments, and laboratory work, while Joey applied for hospital charity care. The account distinguishes this later buprenorphine treatment from her earlier Vivitrol prescription: both belonged to a changing course of care, not to a single uninterrupted medication plan.

The treatment bridge and its limits

In March 2017, the only inpatient facility then willing to accept Joey was a free, faith-based program in Charlotte that did not permit Suboxone or other drugs. Joey chose to taper off medication-assisted treatment to qualify for admission. Cheri worried about the decision, particularly because Joey also faced bipolar depression and probable PTSD, alongside addiction and use of multiple drugs. In Cheri’s view, an ideal course would have taken Joey directly from Vivitrol into rehabilitation, using the month-long injection as a bridge against cravings.

That proposed bridge captures both Vivitrol’s particular promise and the limits surrounding it. The medication’s duration could align with the difficult transition into residential care, but access depended on more than pharmacology: insurance loss had already interrupted Joey’s earlier treatment, and a facility’s medication policy later shaped the choices available to her. Vivitrol therefore appears not as a cure or a guaranteed route to recovery, but as one treatment option whose potential depended on whether the surrounding system could keep care connected.