Drug Courts Partner with Pharmaceutical Company to Combat Heroin, Alcohol Abuse

The 406^th District Drug Court in Webb County, Texas has turned to a new approach for breaking the cycle of addiction related to heroin, opiate and alcohol abuse: The court formed a partnership with Irish pharmaceutical company Alkermes plc to provide a drug called Vivitrol to drug court participants.

Vivitrol is an intramuscular medication delivered once-monthly by injection. It works to block the production of endorphins, which in turn prevents the brain from producing surges of dopamine – the body’s pleasure hormone. Essentially, Vivitrol prevents a person from getting high or drunk. As a result, if a heroin addict shoots up or an alcoholic takes a drink, he or she won’t feel anything pleasurable – although Vivitrol is only meant to be used after a person has detoxed or stopped drinking.

A primary benefit of the drug compared to other medical treatments, such as Suboxone and methadone, is that Vivitrol is not addictive.

One dose of Vivitrol lasts 30 days, though the drug is expensive; the cost can range from $800 to $1,200 for a single shot. Alkermes agreed to a three-year partnership with Webb County in which the company will provide one free dose of Vivitrol to drug court participants – a $200,000 commitment

The court also received a $1 million Substance Abuse and Mental Health Services Administration grant to implement a client treatment plan that includes Vivitrol and cognitive intervention. In addition, Webb County Commissioners approved a half-million dollars in November 2012 to build a new adult detoxification and residential treatment facility for drug offenders. Vivitrol will be given to people released from the residential program.

The drug is not without its critics, but has been used for three decades. Known side effects include possible liver damage or hepatitis, risk of overdose if patients continue using drugs or alcohol while taking Vivitrol, and allergic reactions and depression.

The federal government first developed the drug Naltrexone some 30 years ago to prevent heroin relapses. It was approved by the Food and Drug Administration (FDA) in pill form in 1984 as a treatment for heroin addiction, and in 1994 for alcoholism.

But the drug required a strict regimen of daily doses. The National Institute on Drug Abuse funded research in the 1990s to develop a form of Naltrexone that could be delivered by injection. The result was Vivitrol, which was approved by the FDA in 2006 to treat alcoholism and in 2010 to treat opiate addiction.

David McCann, of the National Institute on Drug Abuse’s Division of Pharmacotherapies and Medical Consequences, said a Russian study used by the FDA to grant approval found that more than one-third of Vivitrol patients – 36% – stayed drug-free and in treatment for six months, compared to less than one-fourth – 23% – of those not taking the drug.

But John Schwarzlose, who heads the Betty Ford Center in California, is among the skeptics who warn that research on Vivitrol is “spotty.”

“The pharmaceutical company will have you believe it is the cure for alcoholism,” Schwarzlose wrote in an email to the St. Louis Post-Dispatch. “But recovery is learning to live without mood-altering chemicals.”

Still, testimonials of Vivitrol’s success caught the ear of Gil Kerlikowske, then the head of the White House’s Office of National Drug Control Policy. After visiting a clinic in St. Louis, Missouri in August 2012, Kerlikowske told the Post-Dispatch that Vivitrol and similar drugs represent the future of addiction treatment, which until now has relied almost exclusively on therapy or medicines that are just as addictive as the drugs they are designed to replace.

St. Louis Circuit Court Judge James Sullivan, who oversees the city’s drug court, began referring offenders to Vivitrol centers instead of prison more than three years ago. He said 60 to 70 defendants on his docket are taking Vivitrol in addition to mandatory therapy in the 11-to-16-month program.

“Vivitrol has assisted us in reaching some very difficult long-term addicts and alcoholics who have not been able to benefit from listening to drug treatment programs that are focused on treatment rather than the cravings,” Sullivan said.

In 2011, the Journal of Substance Abuse Treatment published a study in which researchers examined 64 participants from Sullivan’s court plus two Michigan drug courts. Half received monthly Vivitrol injections in addition to therapy; the others received only therapy.

The study, funded by Alkermes, determined that Vivitrol patients were about 57% less likely to miss drug court sessions than those who participated in therapy alone. Additionally, only 8% of those treated with Vivitrol were rearrested compared to 26% of the non-Vivitrol participants. The study estimated that keeping addicts from re-entering the criminal justice system generated savings of between $4,000 and $12,000 per person following an initial arrest.

Four offenders in Hocking County, Ohio are among Vivitrol’s success stories. In April 2014, they were recognized for breaking their addictions in an emotional graduation ceremony attended by family and friends.

“This is not something that is easy,” said Municipal Court Judge Fred Moses, who spearheaded the drive to create a Vivitrol drug court program. He put together a coalition of state and county agencies to secure funding for the program, which began in late 2012.

“It’s not about the court, it’s about the community and those seeking help and who want to be helped,” Moses said.

Authorities in Warren County, Ohio initiated a Vivitrol pilot program in March 2014, led by Common Pleas Court Judge Robert Peeler, who had been actively seeking the medication for heroin-addicted defendants on his docket. Under an $832,000 grant from the Ohio Department of Rehabilitation and Correction, about a dozen people are already enrolled in the program; the grant will cover a total of 120 participants.

“The goal is to try to find some alternative for these non-violent drug offenders to go somewhere other than prison,” Peeler said. “Hopefully, that means back to work; they get their kids back if they’ve lost them. It’s giving people a chance for hope; it’s giving people a chance for success.”

Butler County, Ohio Common Pleas Court Judge Keith Spaeth, who runs the county’s specialty drug court, said state money channeled through the Butler County Alcohol and Drug Addiction Services Board enabled him to start a Vivitrol pilot program. He observed that the results, while not conclusive, have been extraordinary.

“It’s purely anecdotal at this time but there have been amazing results,” Spaeth said. “People we have worked with for over a year and can’t seem to make progress, suddenly they are on Vivitrol and they are like a different person. Their personality changes, and they stop using, and they get a job, and they become human.”

Butler County Sheriff Richard Jones, however, has called Vivitrol programs in jails a “waste of money.”

The drug court in Lane County, Oregon was the first in that state to begin a Vivitrol program, in the summer of 2014. The court received a $38,000 grant from the Oregon Community Foundation to pay for enough doses of the drug to help the roughly 115 eligible people in the county’s Adult Drug Court and Veterans Treatment Court.

“The one concrete report that they continue to hear [is] that it takes away the cravings for the addiction,” stated Lane County Adult Drug Court Director Bonnie McIrvin. “For opiate addicts, that is the biggest draw.”

Meanwhile, Webb County, Texas hopes to use its Vivitrol treatment program as a magnet to attract more funding.

“We want to use this as leverage at the state and federal level to bring in more monies for our program,” said Jesse Hernandez, a licensed drug counselor, grant writer and drug court consultant.

Currently, Vivitrol programs are available in courts, jails and prisons in at least 21 states; however, as with most drug courts, participants are usually limited to non-violent, low-level offenders – even though those convicted of violent crimes would also benefit, and perhaps have the greatest need for such treatment programs.

In February 2014, Alkermes estimated net sales of Vivitrol to range from $90 to $100 million this year. For fiscal year 2013, net sales of the drug were $58.1 million.

Sources: Laredo Morning Times, www.logandaily.com, www.stltoday.com, www.thefix.com, http://registerguard.com, www.daytondailynews.com, www.vivitrol.com, www.cleveland.com, www.rttnews.com

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