State launches new treatment program for opiate addicts

MONTPELIER — The state is launching a new treatment option for recovering opiate addicts.
The pilot program, announced by Gov. Peter Shumlin Tuesday, will support some 350 Vermonters who will use a monthly injection instead of traditional forms of opiate addiction treatment.
Unlike buprenorphine and methadone, the two most commonly used treatments in Vermont, naltrexone is not a substitute for opiates. If someone were to use opiates after getting the naltrexone injection, they wouldn’t experience the high they would normally get.
The injection “blocks the high” from heroin or prescription painkillers, Shumlin said.
The program will be rolled out first in Rutland at the Marble Valley Regional Correctional Facility, aiming to target opiate dependent offenders as they leave prison and re-enter the community. The governor said that he’d like to see the treatment expand to other correctional facilities soon as well, particularly the women’s facility in Burlington.
In addition to prisons, the state will advertise the naltrexone option at residential treatment facilities, and it will be available at the state’s treatment hubs as well.
Naltrexone is not a new drug. It’s been available for some time as a daily pill, and is often used to treat alcoholism. Vivitrol, the injection form of the drug, is fairly new. However, unlike other forms of opiate treatment, in order to use naltrexone, individuals need to have detoxed completely — an unpleasant process that many opioid-dependent people try to avoid.
Secretary of Human Services Hal Cohen told reporters he’s optimistic that naltrexone will be a useful tool in reducing reliance of opiates in Vermont.
Cohen noted that naltrexone is different from the other treatment options that are sometimes sold illicitly or abused, like buprenorphine.
“It’s non-divertable, you don’t get high on it, it’s not an opiate alternative, it’s an opiate blocker,” Cohen said.
For a certain population, the drug could be very effective, Health Commissioner Harry Chen said, but he noted that it is “not a magic bullet for all people who are addicted.”
Although physicians in Vermont have offered naltrexone in the past, usage has not caught on widely, Chen said, citing expense and broad unfamiliarity with the drug. A similar program was rolled out in Missouri, Chen said. However, the drug is fairly new, he said.
Because the treatment requires that users have completely detoxed from opiates, prime candidates are individuals who are coming out of residential treatment facilities or out of incarceration, Chen said.
Dr. Deb Richter, a practicing specialist in addiction medicine, said that the injections will be another valuable tool for treating addiction in Vermont, but noted that the drug will not be for everyone. In addition to the physical recovery from addiction, there are also environmental factors, she said.
Vivitrol injections tend to be most useful for recovering addicts who have taken steps to change the people, places and things that trigger opiate use, she said.
“Until you change those things, the social factors, it’s going to be very hard,” Richter said.
Dr. Gordon Frankle of West Ridge Center for Addiction Recovery in Rutland noted that the pilot targets incarcerated individuals as they leave correctional facilities, aiming to provide those people with more support for recovery.
Opiates impact some 70 percent of offenders leaving Vermont correctional facilities, Corrections Commissioner Lisa Menard said.
Treatment options for opiate addiction have expanded in Vermont in recent years. Some 1,000 more Vermonters are in treatment now than there were in January 2014, when Shumlin made addiction the focus of his state of the state address, the governor said Tuesday.
Yet in parts of the state, demand for treatment outweighs capacity. In October, the treatment hub in Burlington had more than 300 people on the waitlist.
Officials said Tuesday that naltrexone has the potential to mitigate the wait for treatment in parts of the state. Unlike buprenorphine and methadone, doctors do not need a special license to prescribe naltrexone. Any medical practitioner can prescribe it.
Patients take naltrexone for approximately 6 months as they shift into recovery without requiring medication, said Barbara Cimaglio, deputy commissioner of the Health Department.
Naltrexone costs approximately $1,000 per month. Other treatments cost roughly $700 to $800 per month, Shumlin said. He doesn’t anticipate the treatment will impact the Medicaid budget.
The pilot is funded by a $3 million federal grant from the Substance Abuse and Mental Health Services Administration, secured for Vermont by Sen. Patrick Leahy, I-Vt., in August.

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