Opioid crisis best defense may exist in new drug

Vivitrol® is an extended release injectible suspension drug administered by a physician or other medical provider once a month. The medication blocks opioids from acting on the brain. This feature makes it a good choice for preventing relapses in people who have been detoxified from opioids.

(Editor's Note: In order to protect the privacy of Jess' family, The Middlesex East agreed to not identify her last name in this story. The letter A, representing anonymous, is used in reference to her last name to honor that agreement).

MIDDLESEX - Ducking 10 unanswered felony check forgery and larceny charges, Jess A. defiantly refused to admit she had a problem with drugs after being dragged from her needle-ridden hideout in a N.H. hotel more than four-years ago.

She was unemployed. She hadn't showered in days. Woburn Police detectives were searching for her and calling her phone constantly. On days when she hadn't squandered the money she stole to support her and an ex-boyfriend's $1,000 a-day heroin habit, she subsisted off of items infrequently purchased from a hotel vending machine.

But when her father dragged her out of that hotel room and brought her back to his Woburn residence, Jess A., who had been in numerous drug treatment centers since turning 19, was virtually convinced that she didn't need help.

"Oh my, God," the 26-year-old Waltham native recalls, her face flushing with embarrassment. "I fought with him for 24-hours about going to treatment. I was actually telling him I didn't even have a habit."

Just last month, Jess A. celebrated a milestone she had thought impossible: The anniversary of her third full-year of total sobriety. And in that short time, the Woburn resident, who has regained the trust of her family, has undergone a dramatic transformation.

Now a trusted hair-dresser in Woburn, the 26-year-old, who eventually answered to the felony charges against her, has been off court probation since 2017. Living by herself in an apartment near her workplace, Jess A. regularly tries to help others trying to get clean, and she dreams of one-day opening and managing a recovery house for those new to sobriety.

"I worked really hard," said the Woburn resident. "I tried to build bonds and relationships with women who I could be brutally honest with. Now my parents trust me like no other. When I say I'm gong to be somewhere, I show up."

Still actively-involved in the recovery community through a 12-step program, the Woburn resident credits part of her success to a relatively new drug called Vivitrol, which works by blocking the effects of opioids by binding to neurotransmitter receptors in the brain.

Made by Waltham-based pharmaceutical firm Alkermes, the once-a-month injection is just one of three medication-assisted treatment (MAT) alternatives approved by the federal Food and Drug Administration (FDA) for opioid-addiction.

According to proponents of the medication, Vivitrol is markedly different than its two competitors, methadone and suboxone, in that it is the only non-narcotic drug in its treatment class.

For recovering addicts like Jess A., who routinely abused suboxone while prescribed the opioid-based drug years ago, they could have never broken their dependence on heroin while taking medication capable of producing a state of euphoria.

"I think it gives people the opportunity to restore their minds to some sort of clarity and to make the changes they need to their wildly unmanageable lives," said the hair dresser of Vivitrol.

"I can't say it's the only way I got better. But Vivitrol is absolutely part of my story. It's Vivitrol, combined with other things, that got me better," she added, referencing her immersion into a 12-step program and the recovery community.

Medical treatment controversy

Unbeknownst to many steering through the oft-confusing treatment industry for the first time, there is some controversy around MAT alternatives like suboxone and methadone.

Once popularly referred to as maintenance or replacement therapies, the other two FDA-approved medicines are based on models akin to using nicotine gum or patches for smoking cessation. Though those remedies still contain nicotine, the highly-addictive drug in cigarettes, those relying on replacement therapies avoid some of the most harmful and deadly chemicals in tobacco products. In the interim, the replacement therapy acts as a bridge towards total abstinence.

Suboxone contains two active ingredients, including buprenorphine, a synthetic chemical that binds to the same pain receptors in the brain as opioids. Because it's technically an opioid itself, those using suboxone can still experience a high, but that feeling of euphoria is considered much more mild than the high from heroin or fentanyl.

The second ingredient in suboxone, now the most common drug used in MAT therapy, includes the opioid antagonist naloxone. It is this second ingredient that acts as a blocker, which prevents users from getting high by injecting the drug or other street narcotics like heroin.

However, according to former suboxone users like Jess A., she quickly found out that she could get high off of her medication by taking larger doses.

Though admitting that "high" was not as intense and vanished after prolonged adherence to the treatment regiment, she quickly realized she could skip doses, revert back to heroin use, and then pass drug screening tests by resuming her suboxone therapy before meeting with doctors prescribing her the medication.

"I clearly couldn't stay sober when I was on suboxone," said the 26-year-old, who took the drug for years, before her parents caught on to her ruse. "I got high so much. I would take my suboxone for two days and then [use heroin]. The cycle, and amount of thought and planning that went into it, is ridiculous."

"I had been getting high on-and-off for four or five years. You end up [knowing] all these people who are half-off [methadone and suboxone] and end up sharing their scripts," she added. "There are other options out there, and that's something that needs to be talked about more."

According to Alkermes spokesperson Sherry Feldberg, Vivitrol is unique in that it only contains an opioid antagonist. As such, those who take the once-monthly injection experience no feelings of euphoria, nor can they use other opioids while taking the drug.

"Vivitrol is a non-opioid that blocks opioid receptors. So it's unique in that it's the only medication approved by the FDA for opioid abuse that is an antagonist," she said.

When Vivitrol was first approved by the FDA in 2010, many proponents of suboxone and methadone pointed out that patients must be completely abstinent from opioids in order to start a regiment of medication. For many addicts, they just can't meet that criterion.

Some also argue that Vivitrol, which until recently had not been studied extensively by researchers, also appeared to be less effective than suboxone.

However, according to the federally-funded National Institute for Drug Abuse (NIDA), new medical studies indicate Vivitrol is just as effective in treating opioid use disorder as other MAT regiments.

"The good news is we filled the evidentiary void, and also learned that for those who were able to initiate treatment, the outcomes were essentially identical, as were adverse events,” said John Rotrosen, M.D., the lead investigator in a 2017 study that compared treatment outcomes between Vivitrol and suboxone.

“These findings should encourage clinicians to use medication protocols, and these important results come at a time when communities are struggling to link a growing number of patients with the most effective individualized treatment,” NIDA Director Dr. Nora Volkow added in response to the 2017 study, which was published in medical journal The Lancet.

A raging epidemic

According to statistics released last month by the Mass. Department of Public Health, at least 1,617 people in Massachusetts died from opioid-related overdoses in 2018. The February report further estimates that in the coming months, as additional records from 2018 are submitted, that toll could exceed 2,000 deaths.

In a trend partially attributed to expanded access to lifesaving drugs like nasal naloxone and newer restrictions placed on painkiller prescriptions, the number of fatal opioid overdoses in the state has slightly dropped from 2016's record-high of 2,099 confirmed fatalities.

Ravaged by the epidemic, Middlesex Country, which includes all the communities in the Middlesex East's coverage area, has recorded more fatal overdoses than any other area of the state.

In fact, between 2000 and 2017, nearly 2,913 persons died from opioid-related overdoses in the communities clustered between Cambridge and Lowell.

Though most of today's overdoses are being blamed on the illegal production of fentanyl, a synthetic opioid considered 100 times more powerful than morphine, local and state officials attribute the rise of the public health crisis to the wide-availability of potent painkillers like Oxycontin (known in generic form as oxycodone).

In countless cases, those caught in the throes of addiction have claimed their troubles started after being prescribed opioid-based medication. Then after becoming hooked to those pills, which were allegedly heralded upon their introduction to the market as being non-habit forming, users eventually found themselves turning to illegal drugs like heroin as an alternative.

Seeming to support that contention, in 2000, a year before Purdue Pharma's Oxycontin brand painkiller become the best-selling prescription pain reliever in the nation, DPH officials estimated there were 379 opioid-related overdoses in the state.

According to Jess A., by all measures, she could have easily been amongst the tragic roster of those nameless faces included in the DPH's bleak statistics.

For the Woburn resident, whose own addiction started by abusing painkillers, her trajectory didn't change the day her father pulled her from that N.H. hotel. But in the wake of that confrontation, she had made a half-hearted attempt at actually trying to get sober by participating in a 12-step program.

Three months later, she ended up using drugs again. But she had for the first time gotten a taste for living differently.

In the winter 2016, after spending months sitting in her mother's home in Waltham shooting up drugs in her bedroom, something in her finally broke.

"Nothing extravagant or crazy happened. But I had never been so broken in my life. I was sitting in my childhood bedroom floor, shooting up while my family was home, and saying to myself, 'Jess, you know there's a way out,'" she recalled.

Eventually, Jess was kicked out of mother's house, after her parent discovered a bag of needles in her room. The 23-year-old then retreated to a hotel on the South Shore, where she planned on using drugs freely.

But after the first night alone, she realized something had to change. Days later her journey began with a move to Portland, Maine, where she re-immersed herself in the recovery community while committing to taking Vivitrol.

"I said to my father last night, 'I'm 26-years-old, but I feel like I've lived nine lives.' I wouldn't change it for the world. My new perspective, my compassion for other people and myself, is something I feel like a lot of people don't have," she said.

"Drug addicts are strong and resilient people. We can adapt. As long as there's enough desperation and willingness within you, we can change," she added. "It's insane what we can become if we're [willing to be honest with ourselves]. I don't think that's talked about enough."

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