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CRC finds combination treatment with Vivitrol promotes longer stays

January 23, 2013
by Gary A. Enos, Editor
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One of the largest providers of opiate treatment services on a daily basis in the U.S. is finding that a combination of the injectable medication Vivitrol and counseling that focuses on the chronic nature of addiction is preventing patients’ premature discharge from treatment.

The combination strategy is proving so effective that it has led to an arrangement in which CRC Health Group can proceed with its treatment protocol for Aetna health plan members in three states without having to seek reauthorizations from the managed care company every few days during inpatient treatment.

“The way we view Vivitrol is that it is another arrow in the quiver,” says Phil Herschman, PhD, CRC’s chief clinical officer. “It is not the answer to opiate addiction, but it is another intervention that clearly has some efficacy as part of a complete treatment program that focuses on the chronic nature of the disease.”

CRC, the giant for-profit provider that serves nearly 30,000 opiate addicts on a given day at its various programs across the country, clearly is acquiring a great deal of experience in administering the monthly injectable formulation of the medication naltrexone. Herschman says that in the first 11 months of 2012, the company supervised more than 500 Vivitrol injections.

In data it presented last December at the annual meeting of the American Academy of Addiction Psychiatry (AAAP), CRC stated that in an analysis of records for more than 8,000 of its inpatients, those who received at least one Vivitrol injection during treatment had significantly fewer discharges against medical advice (AMA) than did either individuals who were not prescribed the medication or those who were prescribed the drug but never received it. These data, from 2011, were derived from patient records in Pennsylvania, Virginia and North Carolina.

Herschman says CRC is now working with Penn State Hershey Medical Center to examine further a subset of this study population. He adds that data from CRC’s work with Vivitrol also will be shared at this year’s annual conference of the American Society of Addiction Medicine (ASAM).

CRC protocol

CRC calls its specialized program for treating opiate dependence in its residential settings “Provita.” It combines injections of Vivitrol (manufactured by pharmaceutical company Alkermes) with counseling that Herschman says represents an enhancement of the typical individual and group counseling services that patients traditionally receive. Herschman says some of the enhanced counseling consists of education about the disease model of addiction and about the medication individuals will be receiving.

CRC found in its initial analysis that patients receiving at least one Vivitrol injection during treatment had an 85% lower AMA rate, a 37% increase in length of stay, and a 37% lower readmission rate compared with patients who did not receive the medication.

The data indicated that AMA discharges occurred in 28% of patients who were not prescribed the medication, 25% of those who were prescribed the drug but never received it, and only 4% of individuals who received the medication.

Herschman explains that the two most common reasons why a CRC patient who was prescribed Vivitrol would never receive a dosage would be because of an insurance denial or because the patient changed his/her mind about using medication.

Further exploration

Herschman hopes additional research into Vivitrol will help answer several questions about optimal use of the medication, from determining how many monthly doses are ideal in a patient to evaluating whether there is an association between certain patient characteristics and response to the medication.

CRC is referring to its partnership with Aetna, which is in effect in the states of California, Texas and South Dakota, as a “collaborative disease management initiative” in which the managed care company is simplifying its authorization process to allow for an uninterrupted continuum of treatment services that includes Vivitrol injections.

A statement from CRC says, “The program involves early identification of patients at risk for relapse and actively engages them in longitudinal treatment.”

Herschman adds that CRC also is exploring ways in which it could effectively integrate Vivitrol more frequently into its outpatient services for opiate addiction.

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Comments

There is nothing in your article that says Vivitrol is related to less ama's except your claim that it is so. Your facts only show that those who are approved by insurance or who agree to actually receive the injection are less likely to leave AMA. It is a selected population and there are no facts or statistics supporting the claim that fewer ama's in that population are because of what the action of that med is.
Having been a medical director at a large CRC facility, I can tell you that those with valid insurance are rarely denied the med because Alkermes pays up to 500 dollars of the deductible. Many, however, refuse the injection for various reasons. Those that agree to the injection and actually receive it are a population that are further along in their stage of change, meaning more acceptance and understanding of their disease. Naturally these will be less likely to leave AMA. Stating that the reason they do not leave is because of what the injection accomplishes is a complete supposition and misleading and scientifically inaccurate.
There is nothing in the pharmacologic action of Vivitrol that would make someone less likely to leave AMA. It is only an opiate receptor blocker. It does nothing for dopamine tone which is well established in addiction literature as the final common pathway of this disease. Surrender, acceptance, and counseling however do affect dopamine tone. I find Vivitrol useful in some in my practice, but your sweeping claims of what it accomplishes might lead to overconfidence in its action and is misleading in what Vivitrol does for patients.