Get serious about heroin addiction treatment
Providing the ideal treatment for opiate addiction will require a drastic overhaul of the system now in place. This may seem like solving a 1,000-piece jigsaw puzzle, the pieces widely scattered, their edges torn and frayed, but if as a community we help individuals fit those pieces together, the arduous journey of recovery will see many more successes.
In this ideal scenario, a patient is brought into the ER after a heroin overdose. After Narcan has displaced the opiate receptors in the brain and the risk of further respiratory depression has been eliminated, the patient’s family or another member of their support system is called. If the patient does not have a family member or friend willing to aid them with this process, a certified peer recovery specialist, angel volunteer, or recovery coach is provided.
Treatment options are then explored, the way they are when an addict walks into the Gloucester Police Department. The patient is not going to a jail but to a treatment bed. From the hospital, the patient is transported to a rehab facility and urged to stay for a minimum of 90 days (again, suspend your disbelief ... in this ideal scenario patients without private health insurance have been aided in their state-funded health-care application), during which time Vivitrol treatment is begun, in conjunction with counseling and any and all supplementary interventions the facility provides.
When the 90-day inpatient treatment has been completed, the patient may return home if a supportive sober environment can be provided; otherwise they move into a state-regulated sober living house, and begin intensive outpatient treatment (options exist for both daytime or evening IOP). Those in recovery will attend 12-step meetings if this is a helpful part of the individual’s recovery plan. Every 30 days (or sooner if need be), until the patient has healed enough to have the skills and strength to attend appointments on their own, their appointed support person will accompany the individual to their Vivitrol provider to continue medication-assisted treatment.
Vivitrol is an extended-release injectable dose of Naltrexone, allowing the addict a 30-day safety net during which they can put effort into other areas of their recovery (reintegration with family, work, community, etc). Vivitrol holds a huge benefit over methadone and suboxone treatment in that when the individual, in conjunction with his or her provider, feels ready to come off the medication, usually after an average of 15 months, there is no taper process or withdrawal needed.
Vivitrol is an opioid receptor antagonist (unlike methadone, which is a synthetic opiate, or suboxone, a mixed agonist-antagonist opioid receptor modulator), effectively blocking the receptors with little to no side effects for most patients. Vivitrol and Naltrexone (the daily, oral, pill form of the drug) are not habit forming, have zero abuse potential, and very little toxicity.
Essentially, if an addict tries to use on Vivitrol, the euphoric effects of the heroin or pain pill are completely blocked. This holds another huge advantage over methadone and suboxone; a methadone patient can easily use on methadone by staying on a slightly lower dose and simply using on top of the prescribed drug; for a suboxone patient, the drawback is it must be taken daily (and not at a clinic in front of a nurse, like methadone) and a patient whose cravings become overwhelming can obtain opioid intoxication simply by skipping a dose or two before resuming opioid use.
The goal of my suggested addiction treatment is to assure a continuum of care and prevent people from falling through the cracks. When we don’t discharge patients back to the streets mere hours after the acute manifestation of their disease, we gain the opportunity to start someone on the path to recovery.
Today, those seeking inpatient rehabilitation often struggle to obtain referrals, transportation, or insurance coverage prior to the intervention. Aftercare following an overdose is often a piece of paper and a promise to be present at an intake appointment.
For successful use of Vivitrol, a patient must be seven to 10 days opiate-free before receiving an initial injection, and the potential for a relapse between doses is elevated during the first few months. By aiding a patient in gaining admittance to an inpatient rehab directly from the emergency room, where they can begin Vivitrol, the the first barrier to treatment is eliminated. Having someone trained and dedicated to help these individuals, greatly reduces the chance of relapse.
So why do we fail to provide a continuum of care to address this health crisis? Why don't we work as a community, as Gloucester, Mass. has, to make these connections between providers a reality?
Is it because we don’t think of addiction like we think of cancer or other diseases, where the assumption is that the patient will be supported throughout the progression of the illness? Is it because we’re not willing to stand up against the big businesses represented by insurance companies? Or is it because we are willing to accept that the present condition of our mental health and substance abuse services is the best we can do?
Until we can answer those questions collectively, the damage from the heroin epidemic will rise. How many more will die, how many more families will suffer, until we are willing to change?
Christa Quattromani, M.A., is a mental health clinician at Lawrence+Memorial Hospital in New London and administrator of the Shine A Light On Heroin program.
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