One of the debates over substance use disorder treatment is whether including medication-assisted treatment is preferable to detox and therapy alone. The argument is that if an opioid addict takes methadone or buprenorphine (often prescribed under the brand name of Suboxone, a formulation also containing the opioid antagonist naloxone), then they are merely substituting one drug for another. (In Woody Allen’s comedy Annie Hall, Allen’s Alvy Singer imagines one of his childhood classmates recounting her future: “I used to be a heroin addict. Now I’m a methadone addict.”)

It’s true that methadone and buprenorphine are opioids, and that they can be abused. But so can many other drugs. Taken as prescribed, methadone and buprenorphine won’t cause euphoria, merely cessation of cravings and withdrawal pains. Neither methadone or buprenorphine are intended for lifelong use but they can aid in recovery from drug addiction.

The opioid epidemic was in part (maybe a large part) caused by the pharmaceutical companies incorrectly or falsely claiming their new opioids weren’t addictive. This led physicians to prescribe them much more freely than they did earlier opioids. Whether they misjudged the drugs, or merely misjudged the way people would take them, they have profited greatly from their error. (Some are trying to repeat the maneuver overseas now that opioid use is being restricted in the U.S.)

Now there’s evidence that they are trying to do it again with new drugs intended to counteract the problems caused by the old drugs, such as severe opioid-induced constipation (OIC).

Now Side Effects Public Media and National Public Radio report that at least one drug manufacturer is using a lobbyist to steer legislators to its proprietary treatment and to discourage all alternatives.

Alkermes, through the use of lobbyists, is urging legislatures to use Vivitrol exclusively. A once-monthly injection of naltrexone, Vivitrol’s benefits are that it’s tamper proof and not an opioid. It not only won’t get you high, but it will kill your high if you try to take an opioid anyway.

Vivitrol does have disadvantages however. If you became addicted to opioids because of chronic pain – as many did – and you still have said pain, Vivitrol not only won’t help with it but will prevent most painkillers from working. It also is expensive. A junkie might spend less on a powerful opioid in a month than that one shot will cost.

How effective is Vivitrol for opioids? We don’t know because The Food and Drug Administration based its approval on a single study from Russia.

There’s no one solution to opioid addiction that always works. That’s why we need to keep all options available. There’s a time-released buprenorphine implant that will deliver a steady, non-euphoric dose of the drug for months. Cannabis – marijuana if you prefer – shows evidence of being able to treat both addiction and chronic pain. One non -euphoric compound in cannabis – cannabidinol – might help by itself. Where medical marijuana is available, that might be a safer option.

But Alkermes through its lobbyists is demonizing these alternatives, and ignoring its own products shortcomings. I guess that’s business as usual.