Pris­ons fight opi­oids with $1,000 in­jec­tion: Does it work?

Kuwait Times - - HEALTH & SCIENCE -

US pris­ons are ex­per­i­ment­ing with a high­priced monthly in­jec­tion that could help ad­dicted in­mates stay off opi­oids af­ter they are re­leased, but skep­tics ques­tion its ef­fec­tive­ness and say the man­u­fac­turer has ag­gres­sively mar­keted an un­proven drug to cor­rec­tions of­fi­cials. A sin­gle shot of Viv­it­rol, given in the but­tocks, lasts for four weeks and elim­i­nates the need for the daily doses com­mon with al­ter­na­tives such as methadone. But each shot costs as much as $1,000, and be­cause the drug has a lim­ited track record, ex­perts do not agree on how well it works. Pro­po­nents say Viv­it­rol could save money com­pared with the cost of lock­ing up a drug of­fender - about $25,000 a year for each in­mate at the Sheri­dan Cor­rec­tional Cen­ter, 70 miles south­west of Chicago.

Dr Joshua Lee, of New York Univer­sity’s med­i­cal school, said more ev­i­dence is needed to de­ter­mine whether the med­i­ca­tion can help sub­stan­tial num­bers of peo­ple and whether it’s worth pay­ing for, but the early re­sults are en­cour­ag­ing. “It sounds good, and for some of us, it feels like the right thing to do,” said Lee, a lead­ing re­searcher on the treat­ment. Viv­it­rol is emerg­ing as the na­tion searches for ways to ease an opi­oid epi­demic that af­fects more than 2 mil­lion Amer­i­cans and an es­ti­mated 15 per­cent of the US prison pop­u­la­tion. Many ex­perts view pris­ons - where ad­dic­tion’s hu­man toll can be seen most clearly - as a nat­u­ral place to dis­cover what works. Christo­pher Wolf had al­ready served prison time for non­vi­o­lent crimes when he was or­dered into treat­ment for a heroin ad­dic­tion by a judge who sug­gested Viv­it­rol. Three months later, the 36-year old from Cen­ter­ville, Ohio, is clean and work­ing full time as a cook. He now sug­gests the med­i­ca­tion to other ad­dicts. “I don’t have crav­ings,” Wolf said. “I see how much bet­ter life is. It gets bet­ter re­ally fast.”

Viv­it­rol tar­gets re­cep­tors in the brain’s re­ward sys­tem, block­ing the high and ex­tin­guish­ing urges. In some pro­grams, pris­on­ers get an in­jec­tion be­fore re­lease, then fol­low-up shots from any clinic. For decades, re­searchers have rec­og­nized ad­dic­tion as a re­laps­ing brain disease with med­i­ca­tion an im­por­tant part of ther­apy. But most jails and pris­ons re­ject methadone and buprenor­phine, the other gov­ern­ment-ap­proved med­i­ca­tions for opi­oid ad­dic­tion, be­cause they are habit-form­ing and can be abused.

Just ask Joshua Meador, 28, an in­mate at Sheri­dan who hopes to get into the Viv­it­rol pro­gram be­fore his re­lease in Jan­uary. Be­fore in­car­cer­a­tion, he abused both older treat­ment drugs. When given take-home doses of methadone for the week­end, he would sell them for heroin. “When I’m on Viv­it­rol, I can’t get high,” he said. The drug has no street value or abuse po­ten­tial. “You couldn’t de­sign some­thing bet­ter for the crim­i­nal jus­tice sys­tem,” said David Farabee of the Univer­sity of Cal­i­for­nia at Los Angeles, who leads a Viv­it­rol study in a New Mex­ico jail.

“There’s been push­back with other med­i­ca­tions, peo­ple say­ing, ‘We’re just chang­ing one drug for an­other.’ That ar­gu­ment goes out the win­dow when you’re talk­ing about a blocker” like Viv­it­rol. Prison sys­tems in Illi­nois, Ver­mont, Wy­oming and Wis­con­sin are try­ing the drug on a small scale. Michi­gan is of­fer­ing Viv­it­rol to parolees who com­mit small crimes, if ad­dic­tion is the rea­son for their new of­fense. The fed­eral Bu­reau of Pris­ons ran a field trial in Texas and plans to ex­pand the pro­gram to the North­east next year. The drug’s man­u­fac­turer hopes pris­ons will be the gate­way to a larger mar­ket.

Also known as ex­tended-re­lease nal­trex­one, the med­i­ca­tion won Food and Drug Ad­min­is­tra­tion ap­proval for al­co­hol de­pen­dence in 2006 and in 2010 to pre­vent re­lapse in post-detox opi­oid users. The ev­i­dence for giv­ing Viv­it­rol to in­mates is thin but promis­ing. In the big­gest study, spon­sored by the Na­tional In­sti­tute on Drug Abuse, about 300 of­fend­ers - most of them heroin users on pro­ba­tion or pa­role - were ran­domly as­signed to re­ceive ei­ther Viv­it­rol or brief coun­sel­ing and re­fer­ral to a treat­ment pro­gram.

Af­ter six months, the Viv­it­rol group had a lower rate of re­lapse, 43 per­cent com­pared with 64 per­cent. A year af­ter treat­ment stopped, there had been no over­doses in the Viv­it­rol group and seven over­doses, in­clud­ing three deaths, in the other group. The re­sults, pub­lished in March in the New Eng­land Jour­nal of Medicine, have been pro­moted by the drug­maker, Ire­land-based Alk­er­mes, as it mar­kets Viv­it­rol to US cor­rec­tional sys­tems. — AP

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