Opioid treatment success in Armstrong raises hope
There is rare positive news in the battle against opioid addiction: A treatment program in Armstrong County has an almost 70 percent success rate of keeping addicts from relapsing for six to nine months.
The short-term success rate is surprising, given that the National Institutes for Health estimates the relapse rate for opioid addiction can be as high as 90 percent.
And a large percentage of those relapses happen within a week after addiction treatment ends.
Meanwhile, opioid overdose deaths continue to spike. The national Centers for Disease Control and Prevention says fatal drug overdoses, most of them caused by opioids, nearly tripled from 1999 to 2014.
But Armstrong County — with the second-highest overdose death rate per capita of any Pennsylvania county in 2015 — might have found an answer for its rural population, where treatment isn't as accessible as in urban areas.
Vivitrol, a newer form of a known medication to treat drug and alcohol addiction, eliminates cravings for opioids.
It is administered by a medical professional through a shot and lasts for 30 days. It has no street value.
Counseling a must
But the drug itself, like any other anti-opioid drug, isn't enough.
Long-term drug and alcohol counseling is required to change behavior, said Kami Anderson, executive director of the Armstrong-Indiana-Clarion Drug & Alcohol Commission.
Unique to Armstrong County is a partnership between the drug and alcohol commission and a mobile drug clinic dispensing Vivitrol. It administers the drug to consenting inmates at the Armstrong County Jail, ACMH Hospital and other addicted people.
Officials at the Westmoreland Drug and Alcohol Commission and the Westmoreland County Prison have discussed a similar program to reach inmates as they transition out of incarceration and into treatment services.
“That's something that we would like to implement,” said Elizabeth Comer, director of clinical and case management services at the Westmoreland commission. “They're really at high risk for overdose when they're leaving a controlled environment like a jail.”
Vivitrol is somewhat new to the area, with the drug becoming more available in the past two years, Anderson said.
In Westmoreland County, the drug and alcohol commission created a policy last summer that aims to help addicts obtain Vivitrol when they can't afford it.
Requests will be approved on a case-by-case basis, and candidates could receive doses for up to 12 months.
The commission approved its first funding request last week, she said.
The Armstrong County Jail last year was chosen to participate in a pilot program with free Vivitrol given to drug-addicted inmates, who voluntarily received the drug after detoxing from heroin or some other opioid.
But Vivitrol isn't as well known as other anti-addiction drugs such as Suboxone.
“There is a general lack of education in the medical community and the public about the benefits of Vivitrol,” said Amanda Cope, chief operating officer of Positive Recovery Solutions, a Washington, Pa.-based private clinic that operates the van dispensing Vivitrol in Armstrong County and about 20 other counties.
The program provides between 225 and 275 injections a month in Armstrong and surrounding counties.
Although they don't provide drug counseling, they vigorously promote it to their clientele.
The lack of availability of Vivitrol is driving the growth of Positive Recovery Solutions, which is planning to at least double its number of patients as it expands to central and eastern Pennsylvania, Cope said.
Success hard to come by
The nearly 70 percent recovery from opioid addiction in Armstrong County is “ultimately good news,” according to Neil Capretto, medical director of Gateway Rehabilitation, the longtime comprehensive addiction program serving Western Pennsylvania and Ohio.
Gateway, too, has had similar success using drug interventions such as Vivitrol and Suboxone with patients who are still getting medical and counseling treatment after six months or longer, he said.
The biggest problem, Capretto said, is keeping recovering addicts in treatment for those months.
“The vast majority of addicts aren't getting the treatment they need for an adequate length of time for a number of reasons, including the availability of treatment and insurance coverage,” he said.
“Vivitrol or another drug combined with counseling — that is what we do at Gateway, and we have been practicing this for years.”
About 15 people are using the drug at Accessible Recovery Services Inc.'s Greensburg location, where Vivitrol has been available for a year, said Bryan Ward, vice president of marketing.
He estimated 100 patients at the clinic's 13 locations are on the drug and undergoing therapy in conjunction.
Injection and treatment sites in the area are available in New Kensington, Monroeville, Youngwood, Pittsburgh, Bullskin Township and Charleroi.
Opioid addicts need a minimum of a year of drug and counseling treatment, according to Anderson, Cope and Capretto.
Vivitrol vs. Suboxone
Armstrong County residents didn't always have easy access to Vivitrol, a drug that must be administered through an injection by a medical professional.
“It took years and years to get here because every doctor we asked didn't want to get involved,” Anderson said. “They didn't want ‘those' people in their waiting rooms.”
The most prevalent drug intervention in Armstrong County has been Suboxone, which can be successful in treating drug addiction.
But Suboxone requires regular visits to a clinic to get the drug, which must be taken daily.
“Suboxone works if used right,” Anderson said. “But it's abused a lot.”
Getting a Suboxone prescription is as easy as failing a drug test and coming up positive for opioids.
Although Pennsylvania law requires anyone with a Suboxone prescription to be enrolled in a treatment program, “the definition is loose and some people think just going to a (Narcotics Anonymous) meeting is enough,” Anderson said.
Besides, there is no mechanism for a person to prove he or she is in treatment, she added.
It's much the same with methadone, where pills can be taken and sold — sometimes outside of a methadone clinic — thus compounding the problem.
The two treatments are effective, but it seems problems with Suboxone are more profound in rural areas where treatment options are limited.
People can get high from Suboxone, which can be sold on the street — a problematic scenario Anderson has seen too often with her clients.
“They tell their doctors they need more than they need and keep some for themselves and sell it on the street to raise money to get by,” she said.
Addicts will use Suboxone until they get their next heroin fix, Anderson said.
Another challenge is the rural nature of Armstrong County, where it can be difficult to get to counseling or a clinic regularly, according to Pat Fabian, chairman of the Armstrong County Commissioners, who worked in the mental health field as a counselor.
Since Vivitrol is administered only once a month, it is the best course of action for a lot of people, Fabian said. “But again, everybody is different.”
He advocates strongly for the Vivitrol shot and drug counseling to be administered under one roof.
Fabian and others say there is a disadvantage in having Suboxone and methadone clinics be separate from counseling.
“Pairing is a must; it goes hand-in-hand,” Fabian said. “The relapse rates increase significantly without the therapy component.”
The largest problem, however, is persuading a drug addict to get help.
Addiction counselors estimate only about half of drug addicts choose to go into treatment programs.
Mary Ann Thomas is a Tribune-Review staff writer. She can be reached at 724-226-4691 or firstname.lastname@example.org. Staff writer Renatta Signorini and freelance writer George Guido contributed.