With heroin use among young people in Orange County skyrocketing in recent years, public health officials are encouraged by a new drug therapy that offers a better, cheaper way to beat this most dangerous of addictions.
The drug, called Vivitrol, is administered as a once-a-month injection and offers the possibility of weaning addicts off heroin and opiate drugs in a matter of months.
Health advocates are particularly excited about Vivitrol, because unlike methadone, which has long been the most common treatment for heroin addiction, it has no potential for abuse and does not require daily doses.
Estimates of government costs for Vivitrol range from $550 to $840 per injection, making it significantly cheaper than the total costs of a methadone or other longer-term treatments.
“This gets people back on their feet faster, and in the long run, it saves money,” said Al Senella, the president and a founder of the Tarzana Treatment Centers, which offers Vivitrol through its 14-clinic, nonprofit organization, including a Long Beach facility serving Orange County.
By July the county Health Care Agency plans to start a pilot project using $100,000 in state money from the AB 109 prisoner realignment program. About 30 former addict inmates who are due for discharge from county jails will receive the Vivitrol injections.
While public-health advocates applaud such pilot programs, those in the trenches fighting against the ravages of opiate drugs stress the need to make the Vivitrol injections even more widely available as part of the regular formulary of the state Medi-Cal program.
Currently, the injectable form of Vivitrol is only available under Medi-Cal after individual state approval of a special “treatment authorization request” or TAR. Clinic personnel say this at times has taken weeks, but a Medi-Cal spokesman said it now averages eight days. Addicts who don’t have quick access, are likely to relapse, health authorities have said.
Budget Cuts Come at Bad Time
The need is especially glaring in Orange County, given that the HCA's methadone program fell victim to budget cuts in 2009, despite rates of both opiate use and overdose deaths were beginning show an increase that has continued unabated.
“This should get people’s attention,” said Brett O’Brien, administrator of the HCA’s drug and alcohol treatment program. “Heroin abuse really has been increasing.”
For the three years 2006 through 2008, the number of people 18 to 25 who were admitted to county-connected clinics because of heroin or other opiates was 691 or 12 percent of the total of 5,760 admissions, he said.
But in subsequent fiscal years, this percent of annual opiate-related admissions increased dramatically, reaching 553 or 44 percent of 1,250 admissions during the 2011-12 fiscal year.
County clinics don’t offer Vivitrol now, O’Brien said, and there is only a minimal methadone program, under which the HCA pays $300,000 to two private clinics in Fullerton and Stanton.
County coroner’s records indicate that deaths from opiate drugs also are of concern.
Records show that in both 2011 and 2012 there were 34 accidental overdose deaths from heroin and other opiate drugs among individuals 18 to 25. In each year, a total of 191 people died from various drug overdoses.
In recent weeks, Senella has advocated Medi-Cal coverage for Vivitrol at hearings of the state Legislature, as he has since the U.S. Food and Drug Administration approved Vivitrol for injectable use less than two years ago.
But so far the state Department of Health Services that runs the Medi-Cal program is unconvinced. A spokesman last week said the agency had no plans to add Vivitrol to the regular formulary.
The department is concerned about “significant” costs, even though the federal government pays for at least half.
“It is possible that for some patients this drug provides a safer and more efficient alternative,” according to a Medi-Cal statement.
But Medi-Cal officials also cited limitations: possible reduced monitoring between monthly injections that could lead to relapse and possible overdosing if users inject opiates while taking Vivitrol, which might mask opiate effects.
But even with its limitations, Vivitrol has the potential to be a breakthrough, according to not only health experts but addicts themselves.
Addicts Tout Therapy
Denise F., 52, an employee of the Tarzana Treatment Centers with a history of opiate addiction, has been drug-free since her four Vivitrol injections about 2½ years ago.
Denise, a self-described fast-lane San Fernando Valley girl from a stable, well-off family, said her life reflects those of many of today’s heroin addicts.
Injured as a passenger in a motorcycle accident at 17, Denise was introduced to opiates during hospitalization. That began a 25-year history of drug abuse, various treatments and finally a decade of being drug-free. But at 49, after being given opiates following a spinal fusion operation, she relapsed.
“I was pretty hopeless,” she said. “It was depressing losing everything I had built up with hard work and perseverance. Vivitrol helped me tremendously. It was like a safety net, helping you deal with the wreckage of life."
For those with cash or private insurance, a single injection of Vivitrol costs about $1,100. Under the Medi-Cal TAR system, the drug’s discounted cost for the state is about $840 when administered at some approved clinics, like those operated by Tarzana Treatment Centers, officials say.
Treatment Cost About Half That of Methadone
If the drug is injected at a federally qualified health clinic, of which there are several in Orange County, the government’s cost is about $550.
One fear expressed by state Public Health Department officials is that transient Medi-Cal users may be more likely to have the drug prescribed by physicians at the higher insurance rate.
But national authorities said such concerns may be unfounded, based on recent studies comparing Vivitrol to methadone and such agents.
Rather than providing methadone and other maintenance drugs that replace heroin, authorities note practitioners should be seeking to break the drug-use cycle via treatment with a drug like Vivitrol in conjunction with counseling and monitoring.
“We are at a point, due to scientific advances, we need to focus on the use of medications in the treatment of opiate addictions,” said Mady Chalk, director of the Treatment Research Institute in Philadelphia.
“Studies suggest that the use of Vivitrol generates greater cost savings than most other medications,” said Chalk, a social worker with a doctorate who was a top official at the federal Center for Substance Abuse Treatment in Maryland.
In a 2011 study published in the Journal of Managed Care, Chalk and colleagues showed that the cost of Vivitrol was about half that of methadone, which was statistically significant. The study included 156 privately insured individuals taking Vivitrol and 1,916 methadone patients. All subjects were followed for at least six months.
But with the state Public Health Department still unconvinced, it will take aggressive legislators to include language in a bill to put Vivitrol on the Medi-Cal formulary.
Tom Renfree, the Sacramento lobbyist for statewide county drug and alcohol programs, said advocates like Senella are seeking such language, which could be added to the health department’s budget measure during hearings in the coming weeks for the 2013-2014 fiscal year beginning in July.
Whatever occurs, the Orange County HCA has the funds in hand to proceed treating the initial inmates.
“We are excited about the project,” said O’Brien. “For sure, the need for heroin isn’t there after a Vivitrol injection. It reduces the craving as well as preventing the high.”
The county has already hired a case manager, O’Brien said, and is working out arrangements to provide physician oversight. Both the county Probation Department and the sheriff are supportive, he added.
If the project is successful, O’Brien said, the agency will consider its options on offering the drug more widely.
Rex Dalton is a San Diego-based journalist who has worked for the San Diego Union-Tribune and the journal Nature. You can reach him directly at email@example.com.