Vivitrol Program Key in Recovery Treatment
by Judi Currie
Posted in Foster’s Daily Democrat and seacoastonline.com 11/26/2017, original article may be viewed here
As providers look for all tools to help fight the opioid epidemic, officials at the ROAD to a Better Life Addiction Treatment Facility in Somersworth are seeing success in some of the toughest addiction cases.
ROAD administrator Tom Barnes said they started using medication called Vivitrol about three years ago and most patients came to them through the Drug Treatment Court at Strafford County, which began as a pilot program in 2004. The clinic has an agreement with the court to run the Vivitrol treatment program and is working with 30 to 40 patients
Drug Treatment Court Director Chris Gowell said for people in medically assisted treatment (MAT) Vivitrol is one of the more preferable options.
“It’s extremely helpful,” he said. “Having Vivitrol as a tool for the opioid epidemic is crucial. It’s just another player in the game as far as recovery and I’ve seen it work. It gets them to a point early on where they can start engaging in recovery.
ROAD’s Vivitrol program is run by Dr. Charles Dreibelbis and clinic manager Tammy Britton.
Barnes said a lot of providers were reluctant at first because they weren’t very familiar with Vivitrol, but not Dreibelbis.
“I’d been interested since 2014 so I drew up a protocol and about a year later the company jumped on board,” he said. “When the MOB came out doctors were still reluctant and there are other options for MAT, but where other options routinely failed, Vivitrol would show success.”
Dreibelbis said Vivitrol helps patients stay clean long enough to get them into cognitive therapy, go to 12-step meetings and perhaps volunteer in recovery services. “It has helped a significant number of people who wanted to stop,” he said.
Vivitrol is a form of Naltrexone in a 28-day extended-release method that blocks the effect of heroin, he said.
“When you block opioid receptors it is also blocking the dopamine receptors,” Dreibelbis said. “If you use alcohol it stops the pleasurable quality.”
He said dopamine is a motivation system that tells the brain what do. Food, water and sex are all normal things that are opposite of the flight response, Dreibelbis said, so people dealing with addiction often struggle with what he calls the “blahs.”
“Drugs mimic our system response but they’re 10 times stronger,” he said. “They pushed the dopamine tolerance so high they have to give it time to recover … the average is about six months for recovery of the dopamine response.”
Britton said one patient was addicted for 27 years and she said before Vivitrol she never laughed.
“She had just gotten out of jail, her parole officer brought her in with an ankle bracelet on,” Britton said. “She told me she had not been clean for five years – overdosed the day before – and had done everything to get clean. We put her on Vivitrol. She is on her fifth or sixth shot and is becoming a counselor. She said Vivitrol is the first thing that ever helped her.”
Britton said people can sometimes feel the Vivitrol is working so well they can go off of it. “They say, ‘Oh I’ve got this. I don’t need to keep taking this, I’m good,’ but then they come back because they didn’t realize how much it was really helping,” she said.
Barnes said each patient is different and the more modalities used the better the success rate. Behind self-medicating are often underlying issues of depression or anxiety that must be dealt with. Dreibelbis said when patients receive treatment they try to fix their environment, such as bad relationships, not having a job or couch-surfing.
“We get them back involved with a hobby they may have dropped because of getting high and seeking the next high was all they had time for,” he said.
Continuing the state’s Medicaid expansion is crucial as it has allowed many to get coverage for addiction treatment. “For those who cannot afford a $1,500 injection a month it wasn’t even an option,” Gowell said. “Having it covered by insurance is crucial.”
He said the state needs more detox centers and long-term residential care. “You finally find someone a bed, get them into in-patient facility, then they fall flat on their face. You’re trying to cure what could be 8, 10 or 25 years of opioid addiction with a 28-day stay,” he said. “It gives them a stepping stone but without the supports and a 90-day residential component it ends up being multiple treatment episodes.”
Gowell said putting the money up front saves money in the long run because people are not relapsing.