Seacia Pavao Photography: Robert F. Forman, PhD, of Alkermes
When pharmaceutical company Alkermes, Inc.decided to include treatment professionals in long-term recovery in its “Touchpoints” recovery support campaign for Vivitrol, its medication to treat alcohol dependence, the Cambridge, Mass., company hit on something important. Alkermes' approach recognizes that addiction treatment programs, historically resistant to medication treatments, are more likely to listen to people in recovery than to sales representatives. And the professionals Alkermes has enlisted are spreading the message with a sincerity that at once elevates the conversation beyond the profit motive and brings it down to the level of patient and counselor.
“Throughout my career in the addictions treatment world, this is the first time I've agreed to help a pharmaceutical company with a message,” says Christopher R. Wilkins Sr., president of the Pittsford, N.Y.-based Loyola Recovery Foundation and one of about 20 consultants for Alkermes on Vivitrol, together a group representing every key sector of the field. “I did this because I've been in recovery for 17 years, and I remember what those early years were like trying to keep off craving, just with rational support. I would just want someone to lock me in a room so I couldn't hurt myself.”
Wilkins' own anxiety-ridden moments during early recovery could have been prevented by Vivitrol, he says, adding that every treatment provider should want to give this chance to patients.
Approved by the Food and Drug Administration (FDA) in 2006, Vivitrol is an injectable form of the drug naltrexone that stays in the body for 30 days. The medication directly affects the part of the brain where the drive to drink is located, but for it to be effective, counseling is necessary as well.
In essence, then, the message about Vivitrol's role in overall treatment is not all that different from that used to promote other alcohol treatment medications that preceded it. What differs this time, and what might vault Vivitrol to the kind of marketing success that has eluded other drug companies, is the extent to which Alkermes has reached out to non-physician providers in the addiction treatment field, using some of these targeted individuals' colleagues to spread the word.
Johnny W. Allem, the former president of the Johnson Institute and in recovery for 20 years, is another of Alkermes' consultants for Vivitrol. Far from believing that what they did-“white-knuckle” sobriety without a “crutch”-can and should be done by everyone, Allem and Wilkins say in their roles as leaders in the recovery movement that the treatment field should welcome anything that can help patients get and stay sober.
But treatment program resistance to medications is “deep in the culture,” says Allem. And while the physicians who provide office-based treatment alone might think Vivitrol will “cure” alcoholism on its own, they're mistaken-counseling is necessary as well, he says. Having people such as him and Wilkins communicate to providers gives Vivitrol credibility with the non-prescribers who work most closely with patients, Allem says.
By virtue of their own recovery, these Alkermes consultants can “share testimonies, not something everybody in the pharmaceutical field can do,” says Allem, who also urges people in recovery who have used Vivitrol to speak up and who says treatment providers should encourage their patients to do so. “Part of my job is to speak to recovering community people and let them know this is a safe thing to do,” he says. “Programs will not believe it unless they hear somebody testify.”
Treatment program resistance to medications stems from the fact that treatment was kept out of the medical field, says Allem, noting that alcoholism traditionally was considered a sin, not a disease. “As 12-Step recovery took hold, treatment still remained outside the healthcare system, as it does to this day,” he says. Allem calls on treatment providers to insist that they are part of the healthcare system. “We have to change how we think of ourselves.”
Wilkins says most programs he has spoken to do want to provide Vivitrol to their patients, but he concedes that some programs “have become so rooted in a 12-Step philosophy that they may not want to venture beyond that.” But an even bigger obstacle, many providers tell him, is the cost-more than $900 for a one-month dose. “I talked to several programs that said that if they had the resources, they would want to provide this,” he says.
First dose free
Alkermes is responding to these financial constraints with an offer that is extraordinary in the pharmaceutical world: a free initial dose for everyone who is in treatment. To get enrolled for any patient's first free dose, treatment programs need only to call a hotline at 1-800-VIVITROL (1-800-848-4876).
As of October, Alkermes had reached 2,500 treatment providers through the 50 community forums it had sponsored throughout the country.
“The first free dose ships in 48 hours with no strings attached,” says Robert F. Forman, PhD, director of clinical resources and education for Alkermes. The enrollment form, which the treatment provider and patient complete and is necessary for the first free dose, includes the patient's insurance information. Then the clock starts ticking, and gives the “hub”-the people who process the forms and get out the doses-almost a month before the next dose to verify insurance benefits, says Forman. Alkermes has not tracked how many patients go on to receive a second dose of medication.