In the world of medication-assisted substance abuse treatment, there are three prescription drugs that are the most widely known: methadone, Suboxone and Vivitrol.
Traditional Opioid Agonists
Methadone and Suboxone have been the most widely used drugs in addiction therapy in West Virginia. Both are synthetic opioid-based medications that react with opioid receptors in the brain just as heroin or prescription narcotics would. These drugs are often used to wean people off of illicit drugs like heroin or prescription painkillers like oxycodone.
Dr. Erika Pallie works at Valley Alliance Treatment Services, a private medication-assisted treatment clinic in Morgantown, has just started using Suboxone for treatment, but she most often prescribes methadone.
“So how it works as a medication-assisted treatment is by replacing the drugs that they’re used to and you very gradually increase the dose until the patient is no longer in withdrawal and their cravings are blunted,” she said of methadone treatment.
The problem with methadone, Pallie said, is its bad reputation. Many people hear the name and think about its illegal use on the street, or the doctors who have been arrested for passing out prescriptions. Pallie agreed, it is sometimes sold illegally, but that doesn’t mean the treatment option should be discounted.
“The big complaint I hear is you’re just trading one drug for another,” she said, “which is a very judgmental approach to it and it's coming from an abstinence-based philosophy, which doesn’t really work that well.
“I think that one thing that’s really important is that people need to realize that methadone clinics actually help people.”
Still, there are other barriers to drugs like methadone or Suboxone. For instance, addicts who choose those treatments must initially be supervised when they take the medication, meaning they have to go to a clinic every day to both receive and take the drugs.
A New Treatment Option
Vivitrol is an opioid antagonist. Taken just once a month through injection, the drug enters an addict’s system and coats the opioid receptors in the brain. That prevents an addict from feeling the high that comes with using heroin or prescription narcotics.
While Vivitrol has been used clinically by some health care providers in the state, during the 2015 session, members of the West Virginia Legislature approved a bill expanding access to the drug.
“It creates a unique pilot program within the criminal justice system in West Virginia,” Kanawha County Del. Chris Stansbury said of the bill. He was its lead sponsor.
The Pilot Program
Administered through the court system and paid for with Medicaid dollars from the state and federal government, the pilot program gives non-violent, low-level drug offenders participating in drug courts the option to use Vivitrol alongside counseling and rehabilitative services.
Drug courts are diversionary programs that allow addicts to work toward recovery with a team of medical and legal professionals instead of being incarcerated.
The pilot doesn’t just allow for Medicaid coverage, it also calls for two years of intense monitoring of Vivitrol’s use in five counties.
While those counties haven’t been determined by the West Virginia Supreme Court just yet, Justice Brent Benjamin — who helped create the drug court program — expects that decision to come soon. Then, he said, the data collection will be crucial.
“The one thing that we stress, we underscore in drug courts is that drug courts is an evidence-based program. We can tell what our re-occurrence rate is for people who graduate from the programs. They’re very good, in fact, they’re some of the best in the country, but we only know that because we keep the numbers,” he said.
There are people who say Vivitrol won’t work, like Dr. Rolly Sullivan. He runs West Virginia University Hospitals’ addiction treatment clinic in Morgantown, where he specializes in using Suboxone coupled with individual and group therapy.
Sullivan said he doesn’t believe Vivitrol does much to help with an addict’s urge to get high.
“The cravings, which is that basic, biologic brain illness that is addiction, doesn’t go away when you’re on Vivitrol, and it doesn’t really get treated when you’re on Vivitrol,” he said. “That cravings still sits there and gnaws at people.
“Theoretically you should be able to put someone on Vivitrol and it would work fine. People wouldn’t use drugs because they couldn’t get high, but in reality, people will use Vivitrol once and the chances of them coming back for a second shot a month later are really low and the chances of coming back for a third shot is almost nonexistent.”
Sullivan was once a paid spokesman for Suboxone’s manufacturer, Reckitt Benckiser, but stopped accepting payment for speaking events in 2014.
Addicts Say It Works
Although the Federal Drug Administration hasn’t affirmed the claim, supporters of Vivitrol disagree with Sullivan. They say anecdotally, addicts have told them it does take away that itch to use.
"I’ve heard a lot of testimony on this, and the addicts, independent of one another and in testimony, have said it took my craving away and Vivitrol is the only thing I’ve heard people say that it took my craving away,” Ohio Representative Ryan Smith said. Smith wrote the pilot program for Ohio that West Virginia’s legislation was modeled after.
“That’s the thing we fight because we get people clean for 30 days or 60 days and then they fall off the wagon and end up using again,” he said.
Just like in West Virginia, Ohio administers the medication through state drug courts as an option for participants. Andrea Boxill, Deputy Director of the Ohio Governor’s Opiate Action Team, said while 82 percent of the drug court participants in that state’s six pilot counties chose Vivitrol, it’s not necessarily any more effective than another drug.
“You can use Vivitrol, which for some younger people who are just starting out in terms of heroin, it’s been effective, but it has not been any more effective than methadone, which is something that’s typically prescribed to people who are older who have been using heroin for years,” she said. “Nor is it any more impactful than Suboxone.
“The best way to say it is there is no one size that fits all disease, as with heart disease, high blood pressure or diabetes. You have to treat the individual and figure out which works best for that individual.”
But no matter which side of the fence you’re on, which medication you think is best, medical professionals, judges, politicians, they all say the same thing about the medications. They can’t be used alone. They must be used in conjunction with intense counseling and education.
Once counties are identified, both Justice Benjamin and Delegate Stansbury expect the Vivitrol pilot program in West Virginia to begin quickly. The bill went into effect June 16.
Those eligible for Medicaid or other government assistance within the pilot counties will have the option to use Vivitrol, but no medication or even participation in the drug court program is required.
Court officials expect to have preliminary results from the pilot program to report to the legislature during the 2016 session. A final report is due in 2017.