Vivitrol Injector Program
Naltrexone was first approved to treat opiate dependence in 1984, and in 1994 it was approved to treat alcohol dependence. Vivitrol, an intra-muscular, long-acting, injectable form of naltrexone, was developed in 2005 and FDA approved to treat alcohol dependence in 2006. It was approved to treat opiate dependence in 2010.
(Please see Appendix I for statistics regarding the scope of the addiction epidemic particularly as it pertains to opiate use and alcohol use in The United States.)
Substance Use Disorders have taken a heavy medical and economic toll on our society. We are in the midst of a serious public health epidemic as evidenced by the fact that drug overdose represents the number one cause of accidental death in America. As the DEA has clamped down on the ability to obtain illicit painkillers on the street, many users have turned to heroin as an alternative as it is cheaper and easier to obtain.
Patient populations that are especially affected by substance use disorders include:
Inmates with substance use disorders (and/or co-occuring psychiatric disorders) who are being released from state and/or federal prison and are on parole requiring abstinence as a condition of release;
Patients with co-occuring psychiatric/substance use disorders who are mandated to Assisted Outpatient Treatment (AOT), and must remain abstinent in order to remain in the community
Patients who are treated under NY State Diversion Programs, e.g. TASC, who require long-term abstinence in order to avoid incarceration;
Patients enrolled in long-term residential programs (e.g. Services for The Undersreved (SUS), Samaritan Village, etc…) who want to remain abstinent.
These patients require long-term abstinence from drugs and alcohol in order to remain stable, and thus able to survive in the community. In most cases, once these patients return to substance use, they are either hospitalized or re-incarcerated, either as a condition of parole/AOT requirements, or due to deleterious behaviors associated with substance use.
One of the challenges facing these patients is how to make sure that they are provided comprehensive, FDA approved medication assisted treatment (MAT) for substance use disorders – so that they have the best chance of success remaining abstinent in the community.
A successful Vivitrol Injector Program or “VIP” can address this pressing issue and will have significant medical, psychosocial and economic benefits once implemented.
Our program identifies and treat patients in New York State who are suffering from substance use disorders who:
- Are being released from prison into the community on parole and/or;
- Are mandated to participate in AOT, and suffer from a substance use disorder.
- Are participating in drug-diversion programs
- Are in long-term residential programs
The goal of our program is to demonstrate that successful implementation of a Vivitrol Injector Program will:
- Decrease re-incarceration rates among inmates with substance use disorders who are released into the community and on parole;
- Decrease re-hospitalization rates among patients mandated to AOT in New York State;
- Reduce re-incarceration rates among patients in diversion programs;
- Lengthen periods of abstinence, and reduce re-hospitalization/arrest rates among patients in long-term residential programs.
Our program is under the co-direction of Ramesh Sawhney, M.D. and Scott Bienenfeld, M.D., FAPA, who is certified by The American Board of Addiction Medicine (ABAM). The main location of our site is at 67 Irving Place, in Manhattan. At that location, we have the capacity to treat up to about 80-100 patients per week. We also have sites throughout New York City and Long Island; hence we have the capacity to treat large numbers of patients who require it. We also have the capability to reach out to agencies and provide on-site Vivitrol injections.
We maintain relationships with referring agencies/providers and require that patients receiving Vivitrol injections from our program remain in treatment with their referring provider(s)/agencies. We track all patient data, and ensure that they are followed up with regularly, and that they receive Vivitrol injections every 28 days.
Not only do we make it safe and easy for patients to receive Vivitrol injections, but we also provide direct follow-up and communication with each agency to make sure that clinical care is coordinated. We provide a unified, cohesive program that eliminates the hassle of dealing with Medicaid and commercial payers (we handle all of that). Essentially, we handle everything so that patients receive Vivitrol every 28 days with minimal hassle.
- Opioids are a class of drugs that include the illicit drug heroin as well as the licit prescription pain relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others.
- Opioids are chemically related and interact with opioid receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain.
- Addiction is a primary, chronic and relapsing brain disease characterized by an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
- Of the 21.5 million Americans 12 or older that had a substance use disorder in 2014, 1.9 million had a substance use disorder involving prescription pain relievers and 586,000 had a substance use disorder involving heroin.
- It is estimated that 23% of individuals who use heroin develop opioid addiction. National Opioid Overdose Epidemic.
- Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014.
- From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel. The overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 were four times those in 1999; and the substance use disorder treatment admission rate in 2009 was six times the 1999 rate.
- In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills. Four in five new heroin users started out misusing prescription painkillers.
- 94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were “far more expensive and harder to obtain.”
Alcohol Facts and Statistics
Alcohol Use in the United States:
Prevalence of Drinking: In 2014, 87.6 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 71.0 percent reported that they drank in the past year; 56.9 percent reported that they drank in the past month.
Prevalence of Binge Drinking and Heavy Drinking: In 2014, 24.7 percent of people ages 18 or older reported that they engaged in binge drinking in the past month; 6.7 percent reported that they engaged in heavy drinking in the past month.
Alcohol Use Disorder (AUD) in the United States:
Adults (ages 18+): 16.3 million adults ages 18 and older3 (6.8 percent of this age group4) had an AUD in 2014. This includes 10.6 million men3 (9.2 percent of men in this age group4) and 5.7 million women3 (4.6 percent of women in this age group).
About 1.5 million adults received treatment for an AUD at a specialized facility in 2014 (8.9 percent of adults who needed treatment)5. This included 1.1 million men (9.8 percent of men in need) and 431,000 women (7.4 percent of women who needed treatment)
Youth (ages 12–17): In 2014, an estimated 679,000 adolescents ages 12–176 (2.7 percent of this age group7) had an AUD. This number includes 367,000 females6 (3.0 percent of females in this age group7) and 311,000 males6 (2.5 percent of males in this age group).
An estimated 55,000 adolescents (18,000 males and 37,000 females) received treatment for an alcohol problem in a specialized facility in 2014.
Nearly 88,0009 people (approximately 62,000 men and 26,000 women9) die from alcohol-related causes annually, making alcohol the fourth leading preventable cause of death in the United States.
In 2014, alcohol-impaired driving fatalities accounted for 9,967 deaths (31 percent of overall driving fatalities).
In 2010, alcohol misuse problems cost the United States $249.0 billion.12
Three-quarters of the total cost of alcohol misuse is related to binge drinking.
In 2012, 3.3 million deaths, or 5.9 percent of all global deaths (7.6 percent for men and 4.0 percent for women), were attributable to alcohol consumption.
Alcohol contributes to over 200 diseases and injury-related health conditions, most notably alcohol dependence, liver cirrhosis, cancers, and injuries.14 In 2012, 5.1 percent of the burden of disease and injury worldwide (139 million disability-adjusted life-years) was attributable to alcohol consumption.
Globally, alcohol misuse is the fifth leading risk factor for premature death and disability; among people between the ages of 15 and 49, it is the first.15 In the age group 20–39 years, approximately 25 percent of the total deaths are alcohol attributable.
— Scott Bienenfeld, M.D.
From Nora Volkow, M.D. :
American Journal of Public Health Article: