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This Is Uncomfortable

Police turn to pricey rehab drug for offenders

Miles Bryan Nov 4, 2015
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Cameron Largent, 26,  lives with his mother in a big suburban house in Rock Springs, Wyoming. His favorite spot at home is the basement couch, where he’s set up to play the fantasy video game World of Warcraft. 

“I’m a priest,” he said. “So my job is to run around and heal people. [My character] is the highest level you can get: level 100.”

Largent has had a lot of time to level up recently: he has been sober for six months. It’s the longest he has gone without drinking for years.

“By the time I was 16 I was drinking four nights a week.” he said.  “Eighteen, I was drunk every single night. Nineteen, 20 years old, I figured out the alcoholic’s trick that, if you have a hangover, you can start drinking in the morning to make the hangover go away. So by then I was drinking all day every day.”

Cameron Largent was selected to be part of a trial program to treat addiction.

Cameron Largent was selected to be part of a trial program to treat addiction.

Since then Largent has been in and out of jail for DUI’s and a burglary charge, and, cumulatively,  spent years in different kinds of treatment programs. He managed to stay sober for the last few years, but fell off the wagon about six months ago and got locked up again It was while in jail this last time that Largent was selected to be part of a  trial program of  Vivitrol: a monthly shot that treats alcohol and opiate addiction. Largent received his first shot of the drug on his last day in jail, about a month ago. The effects were immediate, he said.

“Before, when I was trying to not drink and someone, say, cracked a coke can, the first thing that entered my brain is ‘Someone is drinking a beer, and I want a beer,'” he said.  “After the Vivitrol, things like that, triggers like that, they don’t even enter my mind. The craving isn’t there.”

Testimony like that has motivated law enforcement across the country to start offering Vivitrol in jails and drug courts in recent years. Alkermes, the pharmaceutical company that manufactures Vivitrol, has donated doses of the drug to about 30 programs since the U.S. Food and Drug Administration (FDA) approved Vivitrol to treat alcohol addiction in 2006 (the drug was approved to treat opiate addiction in 2010). Many more programs have found funding elsewhere.

Dr. Elina Chernyak helped get some free doses for the Rock Springs area earlier this year — enough to give 25 offenders like Largent a shot on their way out of jail, and a shot a month later. She said medically, Vivitrol is considered a “complete antagonist.” The drug binds with the brain’s opioid receptors and shuts them down, she said, which means that while the Vivitrol is active, opiate drugs and alcohol won’t make the patient feel high. Other opiate addiction medications can actually give addicts a buzz.

But the major difference between Vivitrol and other addiction treatment drugs is how you take it. The shot is administered only once a month. “It eliminates the concerns we have with patient compliance,” Chernyak said.  “Meaning it doesn’t require a patient to remember to take the medication.”

But just because you don’t have to remember to take Vivitrol doesn’t mean it’s easy to obtain, especially if you aren’t getting free doses. Without subsidies a shot of Vivitrol costs about $1,200.

“I think [Vivitrol] is probably more expensive, even with insurance, than many clients can afford,” said Terrence Walton, Chief Operating Officer at the National Association of Drug Court Professionals.

 Vivitrol costs a lot more than other drugs that treat the same kinds of addictions, Walton said, and because of that the public clinics that ex-addicts tend to go to often don’t stock it.

And Chernyak said other, cheaper drugs like Methadone and Suboxone can work better than Vivitrol to treat addiction in some people.

Walton said that Vivitrol is not a “wonder drug.” To treat it as such can be problematic, he said, because all rehabilitation programs need to also target the mental roots of addiction to be successful.

“When [Vivitrol] is truly effective is when it’s used in combination with counselling to address the underlying issues,” he said.

The control room at Sweetwater County Detention Center in Wyoming.

The control room at Sweetwater County Detention Center in Wyoming.  

But Vivitrol’s ability to tamp down cravings,  and to keep people from feeling a buzz if they do slip up and try and get high, has made it very popular with law enforcement. “If you don’t have the craving for 30 days you are probably going to be productive for 30 days,” said Dwane Pacheco, chief of police in Rock Springs. “It means we we don’t see that revolving door.”

According to Pacheco, 60 to 80 percent of crime in the Rock Springs area is alcohol- and drug-related. Beds in the local jail cost $125 a night, and taxpayers pick up the tab.

Without any subsidies Vivitrol is pricey — about $1,200 per dose. But Pacheco says he hopes the state will continue to fund the Vivitrol program here once the trial doses run out. “If we can get them detoxed, and get them working, get them making their car payments and paying rent, then it is a lot better deal for the community,” he said.

Cameron Largent said he’s in counselling as well as on Vivitrol. He hopes that that will be enough to stay sober. Well, that and a whole lot of World of Warcraft.

 

CORRECTION: In the broadcast version of this story, Marketplace incorrectly described what the National Association of Drug Court Professionals does. The organization advocates for the expansion of the drug court field and trains drug court professionals.  NADCP Chief Operating Officer Terrence Walton also says he did not make any statement about why the drug maker, Alkermes, is donating the drug to public agencies. 

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