Jackie D. says Vivitrol dramatically changed and perhaps even saved her life after she spent the better part of eight years addicted to opiates, pouring every penny of her paychecks into drugs with which she was obsessed.
Vivitrol is the newest weapon in the war against the growing problem of opiate addiction, approved for that purpose by the Food and Drug Administration in 2010 after being OK'd for alcohol dependence in 2006. It is an injectable, extended release form (once a month) of naltrexone, used to block the opiate receptors in the brain and help people with alcohol or opiate dependencies stay off drinking or drugs. The medication blocks the sensation of getting high.
"OxyContin 80s was my drug of choice. I probably used four in one day. That's a lot considering they're very expensive [$60-$70 each]," said Jackie, 29, of the South Side, who requested anonymity. She also had taken other prescription drugs and used heroin because it cost less ($10 a bag) than OxyContin.
Jackie, who got addicted at 18 when she was given a prescription for OxyContin for pain after having her wisdom teeth removed as a high school senior in 2000, said she tried to kick her habit "so many, so, so many [times]. I couldn't even tell you a number. You start using; you get bad; you get help; stay clean a little bit. I tried doctors, therapists, rehab. I had methadone once. I've tried to do it cold turkey. I always wanted sobriety, but it's something in my brain."
But an opiates-using friend had told her about Vivitrol and in 2008, the drug addiction doctor she was seeing, Robert Woolhandler, said Jackie could qualify for the injections because of past alcohol use. There was a period in college when Jackie was not addicted to opiates but drank a lot.
Jackie first had to be drug-free for five to 10 days, so she went through a course of detoxification with Suboxone (buprenorphine, which works to reduce the symptoms of opiate dependence, and naloxone, which guards against misuse). She then stayed drug-free for the required time and got the shot.
"Literally within two weeks ... it was like a light turned on in my brain," she said. "I could think again. All my thoughts were consumed with drugs. Drugs, drugs, drugs; how I'm going to get the money. This takes it away. ... You can think clearly again. ... It's amazing how this medicine works."
"[Vivitrol] blocks the opiate receptors. It's like cementing them shut," said Dr. Woolhandler, who in addition to his private practice in Squirrel Hill, is medical director of both the Fayette County Drug and Alcohol Commission and Southwestern Pennsylvania Human Services in Connellsville. "I'll give you an example: If you had a key to go in the front door, I put cement in the front door lock. With the receptors blocked, the opiates can't get into the receptors ... You can't feel the effects."
But the drug has another effect, one that doctors didn't anticipate. "People started coming back and saying the cravings are gone. Not only are the receptors blocked, but the cravings go away," he said. And the cravings are what make staying clean so difficult.
The effects of Vivitol last for a month "so it became a real good tool."
He cautioned that its use should be structured around some sort of recovery program like therapy or Narcotics Anonymous.
And it is absolutely necessary that patients go through detoxification -- Dr. Woolhandler uses Suboxone, which the FDA approved in 2002 -- and be drug-free for seven to 10 days (Dr. Woolhandler requires five to 10 days of his patients) before their first Vivitrol injection. If there is any opiate, including Suboxone (buprenorphine is an opioid medication), in a patient's system at the time of an injection, the patient will go into withdrawal.
Vivitrol is sometimes used for patients at Gateway Rehabilitation Center, which also uses Suboxone for detoxification.
"We talk to them, explain the risks and benefits," said Neil Capretto, Gateway medical director. "Generally, it's a motivated person who wants it. A person who's not that motivated [won't]. Unfortunately, one reality is insurance coverage. It's an expensive shot." The cost ranges from $1,000 to $1,200.
Though other insurance companies cover Vivitrol injections, Highmark does not. Highmark does cover the cost of naltrexone in tablet form, taken daily, "because medical studies show no differentiated clinical advantage to patients taking Vivitrol," company spokesman Aaron Billger said. He also noted that patients who take the tablets don't need to see a doctor for an injection and that the naltrexone is less expensive.
Dr. Capretto has lobbied Highmark officials to change their policy and said he is optimistic that the company will one day cover Vivitrol.
"If a person takes the pill form, they have to take it every day. If a person takes it every day they'll get the same protection," he said. "You have to understand addiction. It's easier to make one decision a month than 30 decisions a month. ...
"I have yet to have someone want the pill. I have prescribed it thousands of times, but compliance is very poor."
Other patients may decide against Vivitrol because of the period they have to be drug-free before getting the shot. They have the option of choosing to use Suboxone as maintenance therapy.
Dr. Woolhandler also has patients who use Suboxone as maintenance rather than try abstinence with Vivitrol.
At Greenbriar Treatment Center, psychologist and chief operating officer Holly Martin said patients have received Vivitrol but "not routinely. ... That's for those who chronically relapse. ... We would never say no to people who really need it, but we're a 12-step program. ... The treatment of choice is abstinence and going to meetings."
Besides cost, which is still less than the price of a drug addiction, another disadvantage to Vivitrol is that patients who slip and go back to using are at risk of overdose. "They've lost their tolerance," Dr. Woolhandler said. "That's the same with anyone at rehab."
Otherwise, he said, "there are very few side effects. You get the shot in the hip. The hip's a little sore." Some people get nauseated or get headaches.
On the positive side, unlike Suboxone or methadone, "It's not addicting. It's as safe as Tylenol. There's no physical dependence. There's no withdrawal."
Dr. Woolhandler said there have been no studies on how long a patient must use Vivitrol before he or she is cured of addiction. He has had patients on it for up to four years. Jackie, who has married and had a child since going off opiates, went off Vivitrol during her pregnancy. But she was given Percocet, a narcotic pain killer, to take after a hard labor and recognized she might have a problem, went through a course of Suboxone again and resumed the Vivitrol shots last November.
"I have a baby. I don't want to screw that up. I'd be missing out on too many things," she said.
At the moment, Jackie does not have a recovery program in place outside of a supportive family but says she will not try to go off Vivitrol for good until she has a therapist.
"I think eventually I'll be able to live without it," she said.
Dr. Woolhandler believes she will, too.
"It's not something we have to figure out [right now]" he said. "She'll live like a normal, everyday life. She'll have kids and hopes and dreams."
Pohla Smith: firstname.lastname@example.org or 412-263-1228.