Vivitrol Drug Court and Medication Assisted Treatment

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1 Vivitrol Drug Court and Medication Assisted Treatment Amy Black, CNP and Judge Fred Moses Court program Self-starters Mission Statement To provide court-managed, medically assisted drug intervention treatment and monitoring program, that assists participants with opioid dependency diagnosis s in developing a sober lifestyle through evidence based intervention and treatment in a non adversarial approach, as an alternative to traditional case processing. 1

2 Medication Assisted Treatment Naltrexone Buprenorphine Methadone A non-opiate (injectable Naltrexone), a full antagonist. A semi-synthetic opioid, a partial opioid agonist medication A synthetic opioid, an opioid agonist medication Blocks opiate receptors, there is no opioid effect. Medically used as a replacement therapy for opioid dependence Medically used as an analgesic and a replacement therapy for opioid dependence Saves lives, restores function Saves lives, restores function Saves lives, restores function Medication Assisted Treatment Naltrexone Buprenorphine Methadone You do not withdrawal You can withdrawal You can withdrawal It cannot be abused It can be abused It can be abused Blocks opiate receptors, there is no opioid effect. Medically used as a replacement therapy for opioid dependence Medically used as an analgesic and a replacement therapy for opioid dependence Medication Assisted Treatment Naltrexone/Vivitrol A non-opiate a full antagonist. Can be costly from $ per 28 days (FQHC price) to $1, per 28 days Blocks opiate receptors- there is no opioid effect. Saves lives, restores function Risk of overdose increases due to consumers lowered opiate tolerance or when attempting to override medication. You do not withdrawal It cannot be abused It cannot be diverted (injectable form) There is no opiate in your system 2

3 Target Population Individuals with misdemeanor charges M3 or Higher are eligible Must be on probation. Must have a dependency diagnosis for opioids from a licensed treatment agency Must complete a mental health evaluation from a licensed treatment professional Must be voluntary and agree to program requirements Motivation Willingness of the individual to receive the medication. Participate in the program and counseling sessions. Become clean and sober and participate in the program is very important when identifying potential participants. Also take into consideration Drug Use History Criminal History Mental Health History Medical History Prior Treatment Episodes 3

4 Assessments ORAS Assessment Alcohol and Drug Assessment Mental Health Assessment A Medical Work up Detoxification White Knuckle Inpatient Detoxification Jail Integration of Services Drug & Alcohol Case Manager Participant Mental Health Court Judge 4

5 Medical Team Clothing Food Participant Dental Medical Card Housing 1 Year, 4 Phase Program Phase 1: The Stabilization Phase: Participants have the most contact with the treatment team They are seen multiple times a week for counseling, drug screens, medical visits, etc Participants come to status hearings weekly 5

6 Phase 2: The Engagement Phase Engaged with counseling throughout their programming, This phase is focused intensely on treatment. They are seen multiple times a week by the treatment team Participants come to status hearings biweekly Phase 3: The Action Stage Begin stepping back the number of appointments they have in a week Encouraged to find employment/school/or other activities outside of the program to help with treatment goals Participants come to status hearings every three weeks Phase 4: The Continuation Phase Step down their appointments with the treatment team Encouraged to continue work toward treatment goals Participants come to status hearings every four weeks 6

7 Maintenance Phase 6-12 months of aftercare relapse prevention plan attend probation office visits attend status hearings bi-monthly Continue to screen on the probation call in system. Current Issues Gabapentin/Neurontin Methamphetamine Staff and Data Collection Requirements Detoxification Program Drug Screens Opiates 10.7% (5.3% before entering) After OPI Buprenorphine 8.9% (5.6% before entering) Marijuana 45.5% Benzodiazepines 6.7% Methamphetamines 7.2% Before OPI After BUP Before BUP THC Cocaine 5.1% Gabapentin 2.6% Alcohol 13.3% Benzo Meth 7

8 Current Program Numbers Program Participants 33 participants Phase 1 Phase 2 Phase 3 Phase 4 Graduate Employment at time of Graduation 8 53 Employed Unemployed Hopewell Health Center FQHC with 17 clinics both BH and PC Serving 9 Ohio counties 8

9 Addiction is a complex disease. VIVITROLextended release injectable form of naltrexone Requires 7-10 days of no opiate use prior to use of Vivitrol 9

10 450 MAT Growth QUICK FACTS More males than females 50% employed Younger Most medicaid-eligible Some self 50% Hepatitis C positive Poor health Trauma, grief, loss COST $1200 per injection 340b $530! Copay card Samples 10

11 Vivitrol and the Liver Hepatitis C Monitoring When to stop??? Monitoring of Liver Function Tests in Patients Receiving Naltrexone or Extended-Release Naltrexone (Springer, 2014) Case Study Late 20 s female History of indiscriminate drug use Lost custody of kids No job No healthcare Detox- at home ALT/AST Levels Mar. 18, 2014 Mar. 24, 2014 July, 2014 Dec May, 2015 ALT AST Levels Column1 11

12 Initial Encounter Insurance Coverage? H & P Birth Control Lab Work CMP, HIV, Hepatitis panel, hepatitis genotyping Linkage to counseling BIRTH CONTROL BIRTH CONTROL LARC Depo Provera OC?? 12

13 Urine Drug Screens Withdrawal Support Anxiety Nausea and Vomiting Diarrhea Muscle Aches Insomnia Meds for Withdrawal Support 13

14 Case Study Age years of marijuana, pills then heroin, street Suboxone Hep C positive Inpatient programs White-knuckled at home Started Vivitrol Hep C treatment- Harvoni Labs are normal. You appear to be cured. 24 months drug-free- I couldn t have done it without the Vivitrol and the counseling patient What else have we tried??? 14

15 Bridge Device Bridge Device History Placement Our results Compounded Naltrexone 15

16 Compounded Naltrexone Introduces naltrexone slowly over 10 days Typical dose is 50 mg tablet compounded at Specialty pharmacy Compound titration dosing Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day mg 0.5 mg 1 mg 3 mg 4 mg 6 mg 12.5 mg 25 mg 25 mg 50 mg Naltrexone Up tapering naltrexone buprenorphine

17 Naltrexone Up Taper In Review: Ideal patient- Suboxone user that just can t make the break Down to the lowest dose possible before starting dose pack In addition to taper blister pack, give withdrawal support meds In office witnessed naltrexone 50 mg dose Then INJECT!! Case Study Age 48 Female Pill user- Percocet then Suboxone from street Tapered from Suboxone-compounded naltrexone up taper Injected with Vivitrol Linked with counseling Challenges Return rate Linking with services Relapse CURE??? 17

18 HARM REDUCTION as a model Successes Reunification with children Employment Continued sobriety Facility level successes: Grown program from one site to 8 sites within organization Contact Info Amy Black, MSN CNP Hopewell Health Center Amy.black@hopewellhealth.org Judge Frederick Moses Hocking County Municipal Court 18

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