Medication-Assisted Therapy Vivitrol

Division of Addiction Services Vivitrol Pilot Overall DAS has a goal to develop a system of care that consistently offers clients the means to enter and sustain recovery To this end DAS hopes to promote evidence based practices in the treatment of addictions One initiative in this area is the planned Vivitrol pilot The DAS goal is to develop a system of care….

Division of Addiction Services Vivitrol Pilot Objective: Support and extend continuous abstinence Afford client opportunity stabilization during treatment acquire skills necessary to independently support recovery transition into Recovery Zone

Medication Assisted Therapy What is Vivitrol? Vivitrol is injectable Naltrexone with the following benefits: Works well with counseling Reduces cravings Decreased impulsivity Enhanced motivation Improved treatment adherence Single injection is effective for four weeks - Eliminates daily adherence decisions Rapid onset of therapeutic effect in the first 2 days Generally well tolerated with a demonstrated safety profile Oral Naltrexone Benefits to Naltrexone, however, compliance is a concern with daily dosing.

Vivitrol Injectable form of Naltrexone Once monthly dosing FDA approved 2006 Manufactured by Alkermes, Inc. An Evidence Based Practice - SAMHSA Treatment Improvement Protocol #49: “Incorporating Alcohol Pharmacology into Medical Practice” What is Vivitrol

Journal of Substance Abuse Treatment January 2009 “The Effects of Extended-release Naltrexone on Holiday Drinking in Alcohol-dependent Patients” With Vivitrol: Better able to avoid episodes of heavy drinking during the holidays Opportunity to deal with the special dangers of alcohol-impaired driving

Choosing the Pilot Cohort DUI Population Higher rate of alcohol as primary drug of choice Looking for evidence of a decrease in DUI offenses (clients don’t go on to offend again) Supported with DUII funding In review of the NJSAMS it was identified that in one year…

Choosing the Pilot Cohort Of clients with primary alcohol diagnosis admitted in NJSAMS: 3,700 admitted to detoxification 985- at least one DUI offense 423- more than one episode of detoxification 288- both multiple detoxification and multiple DUI offenses

Goals for DUI offender participants: DAS IDP Vivitrol Pilot Goals for DUI offender participants: Period of stabilization in which to embark upon recovery Reduction or elimination of DUI offenses Decrease of additional detoxification episodes

DAS IDP Vivitrol Pilot 100 voluntary participants DUI multiple offender Alcohol Dependent Diagnosis DUII eligible Present and admitted for alcohol detoxification Criteria for eligibility in the pilot. First injection at detox discharge offers the client awaiting a referral to the next level of care offers a benefit and incentive to compliance with the next level of care.

Supplemental Services Available to Pilot Participants Physician and Patient Education Up to six injections per client while in treatment Medical visits The pilot is funded by the DUII and in addition to treatment, includes:

DAS IDP Vivitrol Pilot How It Works DUII Network of Vivitrol Providers as a subset of DUII Network who will be trained and eligible for reimbursement for pilot services Clients receive initial injection at discharge from detoxification Follow up injections and continuing care treatment at a DUII/ Vivitrol Provider Agency DUII will reimburse for the medication and all services DAS will develop a network of providers that have capability of providing both the appropriate level of care and medical staff to provide the injections. The initial injection will occur at detoxification and the additional injections are at the next level of care. If a client completes treatment prior to the completion of injections, twice monthly individual sessions with counselor are needed to continue with the Vivitrol medication.

Study the Impact Pursuing offer from CSAT to assist with outcome study Study will assess Client outcomes Costs

Questions/Feedback

Who to Contact? Vicki Fresolone Director of Treatment Services Vicki.Fresolone@dhs.state.nj.us Ann Wanamaker Assistant Chief, Intoxicated Driving Program Ann.Wanamaker@dhs.state.nj.us Lisa Mojer-Torres, Consumer Advocate Lisa.Mojer-Torres@dhs.state.nj.us