It would be nice if there were a silver bullet to treat opioid addiction.
You know, that one thing you can go to time after time, knowing it is going to knock out the problem.
Opioid abuse, including prescription drugs such as oxycodone and illicit narcotics such as heroin, is making headlines here and around the country. And law enforcement, mental health professionals and public health officials are scrambling to address the problem.
One resource could be Vivitrol, a drug given to addicts to prevent relapse with decent efficacy.
It is already in use in Allen County’s Drug Court program, but while results are promising, officials caution the monthly injection is not the be-all, end-all of opioid addiction treatment.
Approved by the FDA in 2010, the drug naltrexone is manufactured by Alkermes under the name Vivitrol and is used to prevent relapse in opioid addicts. It can cost between $800 and $1,200 per dose.
The once-monthly injection blocks the euphoric effects of opioids for up to 30 days. And it is gaining in popularity within the criminal justice system because it has no known abuse or potential for illicit sale, according to a recent study by the New England Journal of Medicine.
The study, sponsored by the National Institute on Drug Abuse, began in 2009 and involved about 300 individuals with opioid dependence who were caught up in the criminal justice system in five different locations in the northeast.
About half the group was given the usual treatment, such as brief counseling and referral to community-based programs, and the other half received extended-release naltrexone in addition to usual drug treatment over 24 weeks.
According to the study, 74 percent of the urine screens of those on Vivitrol were negative for opioids and 71 percent of those same patients showed confirmed abstinence from the drugs at two-week intervals.
"It is encouraging to see data showing, in comparison with a traditional treatment approach, Vivitrol helped to reduce relapse to opioid dependence and protected against overdoses in this patient population. It is also reassuring to see that the frequency of overdoses in patients treated with Vivitrol did not increase after the medication was discontinued," Dr. Adam Bisaga, professor of psychiatry at the Columbia University Medical Center, said in a release concerning the study. Bisaga is a research scientist at the New York State Psychiatric Institute.
"Opioid dependence is a chronic disease that requires an individualized treatment plan, including psychosocial treatments and a medication support, along with monitoring that should extend over the long term to assure the best possible clinical outcome," Bisaga said in the release.
The time to relapse, the distance between the last known use and picking up the drugs again, was more than two times longer in the individuals who received Vivitrol versus those who received traditional treatment, according to the study.
The only incidents of opioid overdose, including two deaths, occurred in the non-naltrexone group.
The drug is currently in use in 100 pilot programs in 30 states, according to the release.
Medicaid and insurance coverage can keep the costs of the drug down, and the manufacturer provides up to $500 per month to help with out-of-pocket costs, according to the company.
Local judge sees merit – to a point
Every Monday afternoon, Allen Superior Court Judge Fran Gull sees addict after addict in Drug Court, a program for those whose struggles with drugs and alcohol have landed them in the criminal justice system.
Gull has used Vivitrol in her program on occasion but has reservations about increasing its use, citing cost and the need for honesty from the addicts.
"You have to have stopped using," Gull said.
To receive the drug, however, a person must be clean of opioids at the time of injection. One of the reasons the program is attractive to jail officials is that inmates are likely clean at the time of their release, when the drug can be administered.
Last year, Scott County Sheriff Dan McClain pushed to bring the program to his jail after the county received national attention for an HIV outbreak among intravenous drug users.
If you lie to a prescriber, and say you’re clean from opioids and you are given Vivitrol, it can kill you, Gull said.
"That scares me," she said. "You have to rely on people being candid with you about whether they’ve taken opioids before you’re giving them the injection. Addicts are notoriously not always candid."
Drug Court participants are required to abstain from drugs and alcohol completely. But Gull is adamant about the need for conventional treatment, such as counseling and group therapy, for successful recovery.
"If we don’t have treatment with the medication, we don’t have any hope they’re going to get better," she said.
Allen Superior Court Judge Wendy Davis is on the governor’s Task Force for Drug Enforcement Treatment and Prevention. She’s been talking to local officials, such as Allen County Health Commissioner Dr. Deborah McMahan about Vivitrol and its potential benefit.
Like Gull, McMahan believes traditional treatment is necessary but is excited about the potential benefit of naltrexone.
One of the biggest risk factors for overdose is a recent release from incarceration, McMahan said.
Inmates haven’t had access to drugs for a while, so their tolerance levels are lower and if they choose to use again upon their release, doses that once didn’t cause a problem can be fatal.
She said if jails or prisons were to begin to administer Vivitrol upon release, the urge to reuse and abuse would be diminished.
"It gives them a chance to kind of get a grip on a sober life, a life of recovery," McMahan said. "I think it’s a good thing, and I hope we do something here locally."