Future of Treatment 

While current medications are “very good and successful,” a new form of injectable naltrexone could significantly improve treatment, according to Saxon. In fact, the injectable form, which is being considered for the VA formulary, would likely be more widely used than the oral form, he said.

The advantage, according to Saxon, is that the effect of the injectable lasts 30 days. Currently, patients take the oral form daily or three times a week and can simply stop taking it if they relapse. The long-acting form would block any “high” from ingesting opioids.

In addition, there is an effort to expand the types of physicians who can provide effective addiction treatment. 

Both Kivlahan and Saxon said the VA would like to see as much treatment as possible in the primary-care setting, especially because the newer medications can be effectively managed there. 

Kivlahan pointed out that, among the average of 1,200 patients in a primary-care practice at the VA, 100 are likely to have substance-abuse disorders and should be treated in a “systematic and effective way.”

The challenge, he said, is to motivate primary-care physicians to take on that responsibility. “The veterans are the best champions. They need to tell primary-care providers, ‘This medication really changed my life.’ ”

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