Voluntary Involuntary Opioid Abuse Treatment

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Kicking an opioid drug abuse habit is one of the most difficult habits to break. So difficult is the prospect of quitting that reports are coming out of Massachusetts indicating that some people facing opioid-related drug charges are asking judges to lock them up – inside a treatment program center for 90 days from which they cannot leave.

These requests are in response to several issues, not the least of which include overcrowded treatment programs with long waitlists that reject patients whose insurance will not adequately compensate the cost of inpatient treatment, often the only way to ensure that those undergoing treatment cannot gain access to heroin or other opioid drugs while attempting to detox. In 2016, roughly 8,000 people will be committed to substance abuse treatment in MA, up 40% from five years ago (Brown, 2016).

Technically, a patient cannot request their own involuntary committal; it requires a close relative, probation officer, or emergency room doctor (or other official) to petition the court on your behalf. If you agree not to oppose the petition, a judge is likely to approve the petition. If a judge agrees to the involuntary commitment, that’s a bed in an inpatient facility paid for by the state, rather than the patient or private insurance, and for a length of treatment longer than for which most insurance programs are willing to pay.

Vivitrol for Opiod Dependence

Photo Source: Vivitrol.com

Treatment prospects are much less diverse for those already incarcerated. The Federal government recently approved spending more than $23 million to fund treatment projects that include giving monthly injections of Vivitrol (Alkermes, Inc.) – a blocker that attaches to certain opioid receptors in the brain and blocks the pleasurable feelings associated with taking opioids (Alkermes, nd.b) – to inmates in an attempt to break the cycle of opioid addiction. Eight states (Arizona, Colorado, Illinois, North Carolina, Rhode Island, Vermont, Wisconsin, and Wyoming) are the recipients of these grants – $2.8 – $3 million over three years (Associated Press, 2016). Each of these states intends to utilize these services to patients in different ways, and at different points in their respective sentences.

In addition to these states, the West Virginia Division of Corrections (DOC) has started a pilot program where it offers an injection of Vivitrol to its soon-to-be-released inmates struggling with opioid addiction. WV, along with neighboring OH and KY, have been incredibly hard hit by opioid abuse. One drawback of this pilot program is that the DOC does not follow up on offenders after they have served their entire sentence, so no information is available on the recovery efforts of six of the participants. This creates a problem with the program, as there is no evidence of its efficacy outside of the incarceration or parole period (Holdren, 2016). Additionally, there are simply not enough treatment centers who provide Vivitrol injections in WV, and those that exist are inconveniently located to those located in some of the hardest hit counties and locations, requiring patients to make 1.5- to 3-hour roundtrips to treatment receive injections.

The primary issue with Vivitrol is the cost – between $1,000 and $1,300 per injection on a monthly basis (Johnson, 2016). For inmates enrolled in Medicaid, Vivitrol injections cost just $3 (in WV); those not on Medicaid must pay their insurance’s prescription fee or foot the entire $1,300 on their own. Alkermes does offer a Patient Assistance Program, which offers co-pay assistance up to $500 each month (Alkermes, n.d.a). Additionally, because the drug is relatively new, there is little evidence, yet, that use of Vivitrol proves effective in the long-term. What data there is, however, points to excellent results.

References

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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