Courts, addicts turn to Vivitrol to combat opioid epidemic amid aggressive marketing

CHICAGO (WLS) -- As the raging opioid epidemic shows little sign of slowing up, a monthly shot is offering a new kind of treatment option.

Vivitrol is the brand name of extended-release naltrexone, a once-a-month shot patients can take for up to a year.

Naltrexone, or Vivitrol, works differently than other conventional drug therapies. It blocks the brain from the effects of opioids.

The injection has been heavily marketed to non-medical professionals including lawmakers, judges, county jails and other criminal justice officials. That marketing started long before the current advertising that is now taking place across the Chicago area.

The I-Team went inside the Will County Jail as a medical team from Family Guidance Centers, Inc., arrived to deliver monthly shots to prisoners with a drug addiction history who were interested in trying the drug.

RESOURCE: What to do if your adult friend or loved one has a problem with drugs

Vivitrol is more expensive than other treatments at about $1,300 a shot, and it requires a full detox first. Advocates of Vivitrol say it's easier to maintain than daily treatments and can't be abused.

RESOURCE: Understanding drug use and addiction

Nick Castiglia, 32, told the I-Team he was addicted to heroin since he was in high school. He said at his lowest point he was revived twice with Narcan after overdosing. He had an extensive criminal history for thefts and burglaries, which he said were the result of his need to pay for his dangerous habit.

Eventually Castiglia was accepted into the Kane County Drug Court program. There he began an intensive addiction treatment program, which included the monthly Vivitrol shots.

The state of Illinois is dedicating millions of dollars in federal grant money to study Vivitrol based programs. Currently Will County and eight other jails are participating in a new pilot program in Illinois.

Less than a year in, the state's most recent numbers show that of 279 people who started on Vivitrol 91 percent continued the shots as part of their treatment program after getting out of jail.

The Assistant Secretary for Programs at the Illinois Department of Human Services said the hope is to try use intervention through the criminal justice system not only to affect their judicial outcomes but also improve addicts' long term health.

RESOURCE: Treatment approaches for drug addiction

The I-Team was granted special permission to recently see one of the drug court sessions in action.

Judge Marmarie Kostelny said she appreciated the manufacturer of Vivitrol marketing to judges because she never would have known about it otherwise, and could not have used it as a tool in her courtroom to help people who have serious addictions.

Critics said health professionals should make recommendations about medication, not those in criminal justice.

They welcomed Vivitrol as an option, but warned the expectations may be too high. They want those in need to know that two other treatments, suboxone and methadone, have a long track record of effectiveness and safety. They said they worry Vivitrol will be offered at the exclusion of other medications.

Judge Kostelny said in her court, medication assisted treatment is not required and Vivitrol is not the only option offered, but she's seeing notable success.

Castiglia now has a full time job, and this week will be graduating from the drug court program. Earlier this month he marked a year of sobriety and feels optimistic about his future.

"If you do mess up, do not give up on yourself. It's a fight and you are going to have to keep fighting the rest of your life," he said.

The manufacturer of Vivitrol declined a TV interview with the I-Team. In an e-mailed statement the company said Vivitrol treatment increased in the general population last year more than 25 percent, but noted that most prison addicts receive no treatment at all. The also said all drug patients should have access to treatment. The company also claimed the $1,300 cost is covered by most insurance. Alternative medications cost roughly $300 to $500 a month and are also covered by most insurance.

RESOURCE: Study comparing Vivitrol & Buprenorphine-naloxone

HOW DO I KNOW IF I'M ADDICTED?

1. Do you think about drugs a lot?

2. Did you ever try to stop or cut down on your drug usage but couldn't?

3. Have you ever thought you couldn't fit in or have a good time without the use of drugs?

4. Do you ever use drugs because you are upset or angry at other people?

5. Have you ever used a drug without knowing what it was or what it would do to you?

6. Have you ever taken one drug to get over the effects of another?

7. Have you ever made mistakes at a job or at school because you were using drugs?

8. Does the thought of running out of drugs really scare you?

9. Have you ever stolen drugs or stolen to pay for drugs?

10. Have you ever been arrested or in the hospital because of your drug use?

11. Have you ever overdosed on drugs?

12. Has using drugs hurt your relationships with other people?

For more information on addiction, visit The National Institute on Drug Abuse

FULL STATEMENT FROM ALKERMES

Overview:
Thank you for your interest in learning more about VIVITROL.

VIVITROL is a once-monthly, injectable, extended-release form of the oral medication naltrexone and the only FDA-approved medication for the prevention of relapse to opioid dependence. VIVITROL is an opioid receptor antagonist, which means it is a blocking medication. It works by attaching to opioid receptors without causing the release of dopamine and blocking opioid molecules from attaching to the opioid receptors. Administered once monthly by a healthcare professional, VIVITROL is non-addictive and is not associated with diversion. Patients must go through detoxification from opioids and be opioid-free for a minimum of 7-10 days before starting VIVITROL.

Research and Science:
There is both clinical and real-world data to support the efficacy of VIVITROL. Since its approval for the prevention of relapse from opioid dependence, more than 350,000 patients have been treated with VIVITROL. In the fourth quarter of 2017, the number of patients treated with VIVITROL reached approximately 33,500 patients per month, which is a 26.4% increase over the fourth quarter of 2016.

In November 2017, results from a National Institute on Drug Abuse (NIDA)-funded study demonstrated that patients who began therapy with VIVITROL or buprenorphine-naloxone, the current standard of treatment, had comparable outcomes. The results, published in The Lancet, reported that about half of people with opioid addiction who took either medication remained free from relapse six months later.

In October 2017, the Journal of the American Medical Association (JAMA) Psychiatry published results from the first-ever study directly comparing the effectiveness of VIVITROL to daily buprenorphine-naloxone. The study showed that treatment with VIVITROL was as effective as buprenorphine-naloxone in maintaining short-term abstinence from heroin and other illicit opioids.

Generating Awareness:
Awareness of VIVITROL as a treatment option remains relatively low and we often hear from patients and caregivers that they want to understand all their treatment options. We are responding to this need and launching awareness campaigns such as the campaign in Chicago, which is aimed to inform patients and caregivers about VIVITROL so that they can consider all available treatment options and have informed discussions with their healthcare providers to choose a treatment plan that is right for them.

There is also a need for greater awareness in other treatment settings. According to a study by the National Center on Addiction and Substance Abuse, 65% of the prison population in the United States is addicted to drugs or alcohol, but only 11% receive treatment. In the face of the expanding opioid epidemic, we believe that all patients, regardless of their treatment setting, should have access to treatment for opioid dependence.

Cost and Access:
The wholesale acquisition cost (WAC) for VIVITROL is approximately $1,300 per month. VIVITROL is fully covered by Illinois Medicaid and managed Medicaid. Most commercial health insurance plans within Illinois cover VIVITROL and with Alkermes' patient co-pay savings program most patients in Illinois have low or no out-of-pocket costs for VIVITROL treatment. VIVITROL is currently covered by Medicaid in all 50 states and has strong national reimbursement coverage by most major insurance companies and public systems. More than 90% of patients have insurance coverage for VIVITROL.