Former inmates get shot at recovery with anti-addiction drug Vivitrol
Warden Edward Strawn believed no news was good news.
When inmates left his Washington County Correctional facility, he often never heard from them again. They stayed out of jail. They weren't reoffending.
It never occurred to him they were dying.
As the opioid epidemic raged and morphed around him, the scope of the problem — and his place in it — slowly came into focus.
"They're in here, they're clean, but that craving's always there," he said. "That's the first thing on their mind when that door opens up – and that's the most dangerous time."
Many addicts will say that withdrawal – or being "dope sick" — is worse than any risk that comes from using heroin, prescription painkillers like oxycodone, Fentanyl and its potent derivatives, and other opioids. Going through withdrawal – for example, during a period of incarceration — does not stop the cravings. It does, however, lower one's tolerance, making former inmates susceptible to overdosing.
"I didn't feel that I was part of the problem, but I definitely wasn't helping," Strawn said.
Adam Kachmarek, 28, of North Huntingdon, looks at a coin marking his efforts to kick addiction to oppiates while waiting for a shot of Vivitrol at Positive Recovery Solutions mobile addiction unit in Kittanning. Kachmarek will receive a shot of Vivitrol monthly which blocks the receptors in his brain, curbing cravings and inhibiting his ability to get high.
So when Washington County District Attorney Eugene Vittone came to him with the idea of Vivitrol, Strawn had few reservations.
Vivitrol, the brand name of naltrexone, is a non-narcotic injection that blocks a drug user from getting high. Perhaps more than that, the drug blocks the cravings that lead to so many relapses. Alkermes, which produces the drug, has made no secret of marketing it to the criminal justice system.
Unlike Suboxone or Methadone, Vivitrol can't be abused. The once-monthly injection takes away the possibility of missing a daily dose – or the temptation to skip a dose and get high.
"It just started with watching people leave here, and I'm thinking they're doing well," Strawn said last month from his Washington office. "Two days, three months later, you see where they overdosed."
Kachmarek gets a shot of Vivitrol from Lugosch in Kittanning. Kachmarek was two weeks into rehab when his cousin, with whom he'd grown up, overdosed and died.
Adam Kachmarek wanted one last hurrah before he went to rehab.
He turned to his cousin, who was two months clean. He asked his cousin to get him the heroin. Standing outside a mobile Vivitrol clinic on an overcast Friday, he'd just gotten his second injection. He said he'd practically begged his cousin.
"I finally talked him into it by saying, 'I'll get you some, too,'" Kachmarek said. "I took him back out with me."
Kachmarek was back in rehab two weeks when the call came.
"As I'm sitting in a group and saying that I'm two weeks clean, I got a call to come into the office, and the call is that he overdosed and he died," he said.
He and his cousin grew up together – sober – and started using together.
"He's dead. If it wasn't me, it was going to be him," Kachmarek said.
"You're trying to find a reason to do it. You're trying to find an excuse," he said. "But there's no good excuse, so you try to find a stupid reason to do it.
"The best thing I can think of – the best reason to do this," he said, gesturing to the large RV trailer behind him, "is to just do it for the people who care about you."
The 33-foot trailer hitched to the back of a pick-up truck doesn't necessarily inspire much hope from the outside, but inside, patients are getting a shot at recovery.
The RV — today parked behind ARC Manor in Kittanning — was repurposed by Amanda Cope and her team at Positive Recovery Solutions. It is a novel yet simple idea: take the treatment directly to those who need it.
One of a growing number of treatment centers working with Vivitrol, PRS is based in Washington County. When Cope discovered that many were driving hours for the treatment, the idea for the RV was born. It travels the region, going as far as Crawford and Blair counties.
On a Friday afternoon in September, the team sees three patients. Two are there for their first shot. Kachmarek is there for his second.
"Everybody challenges it the first time," said Eric McFarren, a former UPMC operating room technician turned logistics director for PRS. Most patients return for their second month with opioids in their system — a test of the drug's high-blocking capabilities. "We have a three-strikes rule."
Eric McFarren, 37, Logistics Director with Positive Recovery Solutions mobile addiction unit rests during a moment of downtime while the unit was staged in Butler earlier this year.
Strawn had his reservations.
His experience with traditional drug and alcohol programs in his jail taught him the care couldn't stop once inmates were released – not if they were serious about treating addiction.
"They had to guarantee me that once (inmates) walked out my door, some type of care would continue," he said. "And they said, 'That can be done.'"
The program is set to run for one year under a $148,000 grant, which was proposed by the Washington County Opioid Task Force. The grant covers the shots and counseling. They're using the early stages of the program to choose inmates they believe have a high shot at success.
The program is still in its early stages. Inmates are chosen by a committee that includes representatives from local treatment facilities, the public defender's office, the jail, the DA's office, and more. If they agree to participate, they receive about a month of counseling prior to release. Their first counseling appointment outside the jail is set before their release.
Five days before release, they receive the shot.
"The shot, honestly, is probably the smallest part," Strawn said.
It is small, but costly.
An expensive drug at $1,000 a shot, Vivitrol is a treatment that has found its earliest audience not in halfway houses or rehab facilities, but rather in courtrooms and jail cells among those facing long odds once they're back on the streets.
"Some patients call it their bulletproof vest against opioids," said Dr. Neil Capretto, director of Gateway Rehabilitation, where doctors are starting more than 500 patients a year on Vivitrol.
The drug was first developed in a pill-form in the 1980s.
"It worked great if you took it," Capretto said. "But compliance was historically terrible with it."
Capretto said one patient told him that as soon as he gets the shot, it feels like all the heroin in the world is launched into space. Others have told him that they tried to get high with the shot in their system and "it was like doing water."
Those aspects – the monthly dose and the inability to get high – help smooth out some of the wrinkles that can come with attempts to get clean, but Capretto said a patient has to be motivated and working through counseling along with the medication – just like they'd have to with suboxone or methodone.
"It's an important tool in our toolbox."
Stuart Masula, 26, of Blairsville, and former Positive Recovery Solutions patient turned employee looks through the window to see if a patient has received their shot of Vivitrol during a morning in Kittanning.
Stuart Masula has come nearly full circle in the past 20 months.
Once a patient at the mobile unit, Masula, 26, now works there. He drives the truck and admits patients at each stop in Western Pennsylvania.
A broken back at age 15 sent him the way of painkillers, he said. From there, it spiraled. He celebrated his 18th birthday in rehab, he said, and promptly signed himself out.
Between 19 and 24, he spent a collective 4 ½ years in jail, including a two-year stint in state prison. He was clean when he left prison, but fell off the wagon soon after.
"After that, I just said, 'I've got to be done,'" Masula said. "I was just sick of my life."
He will sing Vivitrol's praises, but noted that it's not a cure-all.
"My life is leaps and bounds, 100-percent different," he said. "If you do this and actually work at a (counseling) program, it's a game changer.
"I couldn't get (clean for) 30 minutes, let alone a day," he said.
He said the Vivitrol kept him from craving the drugs – or even thinking about them. He said he had only two serious nostalgic moments for his days of using, and the rest were just fleeting thoughts.
Masula is married now – his wife, also a recovering addict, also used Vivitrol – and is expecting a son in October. He's been clean for 20 months.
Strawn and his team are starting with those they know can be successful; Lycoming County Judge Marc Lovecchio, two years into his court's Vivitrol program, takes the opposite approach.
"We take the worst of the worst – the people who are one step in the state prison. I will take those people who would otherwise be dead," Lovecchio said. "These are people at the end of their ropes."
Lovecchio started his drug court's program from scratch in August 2015 after a colleague told him about the Vivitrol injections.
"I kind of got thrown into it," said Sara Steinbacher, a probation officer.
Together, the two started with two inmates in the program and six sample shots from a Vivitrol representative. Now they're up to 15, all suffering from severe opioid dependence.
Steinbacher stressed that the program isn't just a shot and a send-off. Like Washington County, counseling is set up before participants are even released from jail, and they often go right from release to their first session.
Participants must meet with either Narcotics Anonymous or Alcoholics Anonymous daily for 90 days – 90 in 90, Steinbacher calls it. They must meet with their probation officer and their caseworker weekly. They meet as a group with Lovecchio monthly.
"I didn't believe in it. I didn't think an addict could just stop until I started researching," Steinbacher said. She said she realizes that Vivitrol is not a magic bullet, but rather a crutch. She noted that several months ago, the county documented 62 overdoses requiring medical treatment in a 48-hour period.
"Not one of our patients were involved in that," she said. "That was a victory on Vivitrol court's part."
Cassidy Edwards, 20, of Kittanning, and an addict who was recently released from jail for selling heroin fills out the paper work at the Positive Recovery Solutions mobile addiction unit in Kittanning.
Cassidy Edwards has never overdosed, but she knows at least 10 people who have, she said: Six of them died.
She just turned 20 in late August, but said she finds it hard to look forward because of all the hopelessness she sees. She has been on methodone and suboxone and, now, a few weeks after being released from jail for selling heroin, she will try Vivitrol.
"It's upsetting because when does the time-out end?" she said. "When do I get to become a member of society again? They treat you like you have leprosy."
She said her friends' parents chastise them for hanging out with her.
"I'm not trying to poison your child," she said. "I just wanted to be friends with them because I know they're sober. But it doesn't matter."
She wants to believe Vivitrol will be the answer – the final push to get clean and, more important, stay that way.
"I would love for this to be it," she said. "But when you're sitting alone, when you're leaving an appointment or leaving an NA meeting and you have that hurrah feeling in your chest like, 'I can do this.' And then you get home, and you're alone, and you remember, 'I still am viewed as a piece of sh-- by everybody in this community, and it's never going to go away.' That's always going to be my reputation. Even if I do get better, I'll still be 'Cassidy the recovering heroin addict,' and I'll always be held with little kiddie gloves."
Justin Bayne exits the Positive Recovery Solutions mobile addiction unit smiling after receiving a shot in Butler. Bayne relapsed after several months on the shot, but began out-patient treatment again and is working toward getting back onto Vivitrol.
Megan Guza is a Tribune-Review staff writer. Reach her at 412-380-8519, email@example.com or via Twitter @meganguzaTrib. Andrew Russell is a Tribune-Review staff photographer. Reach him at firstname.lastname@example.org or via Twitter @RussBurgh.
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