By Patricia Anstett

http://www.freep.com/article/20120708/FEATURES08/207080589/Revolutionary-new-drug-Vivitrol-offers-new-life-to-addicts

Friday is Amanda Gordon's one-year anniversary of being clean from heroin and prescription drugs, a remarkable recovery she never expected to achieve because she had failed so many times before.

But a monthly injection of Vivitrol has accomplished what nothing else did, including nine stints in hospital detox programs.

Her mother, Katherine Gordon, an automotive warranty specialist grateful for her daughter's release from addictions that devastated her only child and her family, goes as far as to call Vivitrol "the closest thing to a miracle I've seen."

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The drug, approved in 2010 by the U.S. Food and Drug Administration for treating narcotics addictions in adults 18 and older, is an important advance, changing the world of addiction treatment, many doctors in the field say. Vivitrol, compared with other treatments, they say, is more effective, has no potential for abuse and sale on the street, and can be prescribed by any doctor. The drug is prescribed for addiction to heroin and prescription painkillers such as Vicodin and OxyContin, a rising problem nationally, as well as for alcoholism.

Studies in Russia of 250 heroin patients -- data submitted to gain approval from the FDA -- showed 70% of patients who used Vivitrol for at least six months were clean. But the drug's high cost -- about $1,000 per injection -- remains controversial, as does the notion of using an injection to treat drug abuse instead of focusing more on long-term behavioral changes, as prescribed by 12-step prorgrams.

There also aren't any studies to compare Vivitrol with other drugs and "that's a concern," said Dr. Carl Christensen, medical director for addiction services at the Detroit Medical Center. He said the drug can't be used during pregnancy.

The National Institute of Drug Abuse is continuing research on Vivitrol, as is the company that makes it.

After a slow start reaching doctors, family doctors such as Dr. Raghad Lepley, Amanda Gordon's physician in Highland Township, north of Milford, have started prescribing the injections.

"This is a very new era in addiction treatment," Lepley said.

Finding reliefGordon, who turns 24 Tuesday, began using heroin and prescription painkillers at 16 when she was an honor roll student at Waterford-Mott High School.

Heroin was her preference, but she crushed up painkillers and snorted them when that's all that was around. "Your whole purpose was to wake up, get some money and go get it," she said.

Once she started on Vivitrol, the urge to use drugs "wasn't there anymore," Gordon said. "I wasn't obsessing over it. I think if any addict could have that obsession lifted for 28 days, they'd see just what a difference it makes."

In contrast to any physician being able to prescribe Vivitrol, doctors need either special training or certification to prescribe other treatment drugs such as methadone or Suboxone. Both are synthetic versions of opioid drugs such as heroin and OxyContin, leading patients to sabotage their recoveries by sometimes abusing them.

Lepley said Gordon "jumped" at the chance to use Vivitrol because "we don't have a lot of options" to treat heroin and painkiller addictions.

Still, Vivitrol brings controversy because of its cost and concerns that no shot can provide the personal commitment to change that alcoholics and drug addicts must address.

Vivitrol costs $1,100 for each injection. Alkermes Inc., the Waltham-Mass.-based manufacturer of the drug, provides financial help for 13 months that reduces the price by half for people with private insurance and cuts co-pays for patients with Medicaid or Medicare to as low as $5 an injection, according to Richard Pops, CEO for Alkermes.

Doctors who use Vivitrol may try to wean people off the drug after a year, though some may need to take the shots for years, the same as other addiction drugs.

Gordon's Blue Cross Blue Shield insurance pays for nearly all the cost of the drug, but not all insurance plans do, one reason top doctors at two major metro Detroit drug rehab programs say they don't routinely prescribe it.

"I don't recommend it" because "it's just cost-prohibitive at this point," said Dr. Philip Gilly, chief of inpatient services at the Henry Ford Health System's Maplegrove Center in West Bloomfield.

Dr. Jeffrey Berger, medical director for the Brighton Center for Recovery, part of the St. John Providence Health System, said he worries also that a shot is "seductive to patients."

"It's the medicalizing of recovery that concerns me," he said. "What I see happening overall is the tendency to think that treatments come in a pill ... and people are not wanting to do the work for a substantial recovery."

Still, he predicted, Vivitrol "changes the whole ballgame."

Costly national problemMore than 1.8 million Americans are addicted to prescription painkillers such as Vicodin and OxyContin, and another 800,000 are addicted to heroin, according to 2010 data -- the latest available -- from the federal Substance Abuse and Mental Health Services Administration. Another 18.2 million have been diagnosed as problem drinkers.

Addiction is a costly national problem because so many addicts fail in recovery and overuse more expensive care in emergency rooms when they overdose or develop drug-related problems.

Drug abuse involving prescription medicines accounted for 1.3 million emergency room visits in 2010. That compares with 1.2 million visits for illegal drugs, 600,000 for alcohol and drugs combined, and 200,000 for underage drinking, according to statistics released this month by the federal Drug Abuse Warning Network, which tracks drug abuse in the U.S.

Rehab stints can cost $15,000 or more for a week's stay, and centers increasingly report seeing patients like Gordon who return more than a half-dozen times.

Dr. R. Corey Waller is an addiction specialist working with a large drug population that floods the Grand Rapids-based Spectrum Health System emergency department. Vivitrol is "exceptionally good" at treating alcoholism and "doubles positive outcomes" for problem drinkers and heroin and painkiller drug abusers, Waller said.

"The difference is night and day," Waller said of Vivitrol, comparing it with other recovery methods, including counseling alone.

The 12-step programs, the cornerstone of Alcoholics Anonymous and others like it, work no more than one quarter of the time, Waller said, referring to figures quoted widely. "Those numbers don't lie," Waller said.

The national resource group 12Step.org referred questions about success rates to an e-mail list of meetings of its sponsors. Those contacted did not respond. Confidentiality is an important component of the programs and many decline news media interviews.

Drugs in the suburbsGordon was introduced to the world of hard drugs through a former boyfriend, a drug dealer.

She was hooked in less than three months, she said.

Her parents, now divorced, didn't catch on for several years. "She was white-bread America," said her mother, who has remarried and lives in Commerce Township. "She had a 4.0," her mother said. "She had everything going for her."

She said her daughter played tuba in her school's marching band, symphony orchestra and jazz ensembles for awhile. Gordon's mother now understands how widespread drug use is, affecting the suburbs, as well as core city neighborhoods. "To see this kind of epidemic in Oakland County just floors me. I had no idea," Kathy Gordon said.

Amanda Gordon found that snorting heroin or crushed up painkillers didn't get her high enough. Deathly afraid of needles as a child, her friends talked her into injecting drugs because they said she'd get higher, and need less.

But they had to hold her down, as she sobbed, to inject her the first time, she said.

As her addiction grew, Gordon needed more to get high. When she became skinny and withdrawn, her mother started to suspect a problem, but she thought it was an eating disorder because Gordon still was doing well at school.

Kathy Gordon learned of her daughter's drug use after Amanda Gordon fought with a friend, who in turn told her mom that Gordon was a drug addict.

Kathy Gordon insisted her daughter enter rehab. While in rehab, she took the drug Suboxone, but it didn't work for her.

"It's a choice," Amanda Gordon explained. "I'd say, 'I'm going to get high today,' so I wouldn't take it."

At least three of her friends died of drug overdoses.

More ultimatums came from her parents: Get clean or get out. More rehab stints followed, as did enrollment in a methadone program. There, she met other drug users who sold her heroin, Suboxone or clean urine so she could pass the drug tests required to stay in the program.

"People would sell their pee at the methadone clinics," she said. "They don't watch you. You just go in the bathroom."

Two separate police raids within a year on the Gordon family home, where Amanda Gordon was living with her boyfriend after Kathy Gordon remarried and moved out, led to Amanda Gordon's final awakening.

She said she was disgusted with herself and a habit that grew and grew.

On July 13, 2011, Gordon begged her mother to take her to Lepley, whom she had heard about through a friend at a drug treatment program.

She wanted to try Vivitrol.

Finding a way outGordon, savvy from years in drug programs, sabotaged her first Vivitrol shot. She was supposed to be drug-free for seven to 10 days before taking it -- but she wasn't and she lied to Lepley. The combination of Vivitrol and heroin in her system left her curled up in a ball, crying for three days as she weathered painful withdrawal symptoms.

Her mother, who stayed in touch with Lepley and Gordon's friends, did her best to help her daughter soothe the symptoms.

"We got pineapples, strawberries, chocolate dips and Ensure," a liquid nutrition drink, Kathy Gordon recalled.

Somehow Amanda Gordon got through 28 days to her next shot.

Each month, she felt better. She returned to school and got an associate's degree in general studies from Oakland Community College. She dumped the longtime boyfriend and has found happiness in another relationship. She attends weekly Alcoholics Anonymous meetings, which are open to people with all addictions.

She wants to work. She just needs a job.

For now, she busies herself with a new puppy, her boyfriend, working out at a local gym, her job search and occasional talks she gives publicly to people about drug addiction. One in June was to a national organization of court administrators who oversee drug cases.

"I'm happy for the first time in years," she said.

As she planned for her daughter's birthday celebration Tuesday, Kathy Gordon wondered what gift she'd buy her daughter. She might buy her a ring because Amanda Gordon has little jewelry after years of pawning her stuff for drugs, she said in an e-mail.

"The biggest celebration is just going to be having the family together," Kathy Gordon said. "There were so many years that her behavior made it nearly impossible to have family gatherings. She would be late or not show up at all or show up and promptly fall asleep....It was easier just not to plan.

"Today, we have Amanda back, and the monster that impersonated her for so long is gone."

By Lisa Riordan Seville and Hannah Rappleye
NBC News LANCASTER, Ohio --

http://openchannel.msnbc.msn.com/_news/2012/06/07/12091096-crackdown-on-painkiller-abuse-fuels-new-wave-of-heroin-addiction?lite

Holly Yates started using painkillers in the ninth grade, at parties and hanging out with friends. The pills were everywhere, easy to get and cheap. By the time she was 18, she was abusing oxycodone, Percocet and other pill severy day.

Then they stopped being enough. 

“My cousin, she was into heroin and I started hanging out with her,” said Yates, a hazel-eyed 20-year-old. “She told me about it, and I was like, ‘I want to try it.’ The first time that I shot it up, it was like, ‘Where has this been all my life?’”

Experts say Yates and others in this town of about 38,000 southeast of Columbus are on the leading edge of a frightening new drug abuse trend – one that is ironically being fueled by a national crackdown on prescription painkillers. While new regulations and law enforcement efforts have significantly reduced the supply of these drugs, they say, those efforts have inadvertently driven many users to another type of opiate that is cheap, powerful and perhaps even more destructive – heroin.

“It’s an epidemic,” said Dr. Joe Gay, director of the regional addiction and mental health clinic Health Recovery Services, who has studied patterns of drug use in the state.

A flood of cheap heroin from Mexico, which is now one of the leading sources of the drug to the United States, is one reason for the return of the scourge. According to the Justice Department, the drug is showing up in new areas, including upscale suburban towns where heroin was once rare. 

In Illinois, for example, researchers at Roosevelt University have found a spike in young suburban heroin abusers. Long Island, New York, has in recent years seen a rash of addiction among the young. A spike in heroin use and related crime has Dane County, Wis., reeling. Even states like Washington, where heroin has a longtime presence, have seen a sharp increase among young users. In King County, home to Seattle, nearly a third of those entering treatment for heroin abuse in 2009 were between ages 18 and 29 -- a sharp increase from a decade before.

  With increased availability has come a spike in the number of visits to emergency room visits for issues related to heroin use, including a 13 percent increase from 2005 through 2009, according to the national Drug Abuse Warning Network. The highest rates of admission were for young adults, 21 to 24 years old.

“Twenty years ago, half of the heroin addicts in treatment lived in two states — New York and California,” said Gay. "(Now, in Ohio) we’re seeing it spread out of the cities, into the suburbs and into the rural areas.”

The demographics of heroin addiction are also shifting, he said. 

'It's not going away'
Until a few years ago, addicts were overwhelmingly men who lived in urban areas, many of them from racial minorities. An alarming number of those entering treatment programs in Ohio -- a good measure of addiction -- are young, he said. Most are white. They are from poor rural counties and wealthy suburbs. Many are girls and women.

In Ohio, the new face of heroin addiction could be the girl or boy next door.

“Everybody does it,” Yates said. “It’s just here, and it’s not going away.”

Sarah Mayer, 27, was an early traveler on the path from dabbling in prescription pills to putting a needle in her arm.

Born and raised in Hilliard, a tree-lined suburb of Columbus, she grew up in what is, by all accounts, a loving home. Her father works at the local bank. Her mother is a nurse.

Derailed plans
In high school, Mayer went to parties and drank occasionally, but she kept her grades up. During her last year in high school, in 2002, she took college classes. After graduation, she started a fully-paid-for nursing program. But her plans were derailed by addiction to oxycodone, an opiate-based painkiller found in many medicine cabinets across the country.

“I really didn’t know what I was getting myself into,” Mayer said. By 2005, she and her boyfriend were taking the pills regularly to get high. But over time, the effects diminished.

One day in early 2006, Sarah and her boyfriend found themselves nearly broke and without the pills they needed. Desperate and sick with withdrawals from the opiates, her boyfriend left the house to try to find pills.

He came back with a bag of powder heroin.

“He knew how I felt about heroin,” Mayer said. “That was the one thing I said I would never do.”

Young recovering heroin addicts Tej Yaich, 20, Holly Yates, 20 and Tara McCormac, 22, and Dr. Joseph Gay share their stories and discuss the growing heroin crisis in Ohio.

Despite her conviction, within 24 hours, she had snorted it. She would spend another three years chasing that first high. “It was almost like all of the wind was knocked out of my chest, I could barely hold my head anymore,” said Mayer. “It was like my whole body just exhaled.” 

Soon, she began injecting it. It would take her years, and at least six trips to recovery programs, before she successfully got clean in October 2009. She’s now working toward a degree in nursing, and recently made the dean’s list. 

The addiction was something the Mayer family never saw coming. 

“There was never a thought that ever entered my mind that I would ever lose a child through addiction,” said Randy Mayer, Sarah’s father. “Watching this thing grab her and not let go, I mean, it was a horrible time.” 

  But in Hilliard, where he also grew up, Randy Mayer said he is seeing this happen to others. 

“I’ve met some other families, locally here -- they’re dealing with the same kind of situation,” he said. “The fact of the matter is, these towns like this are fertile for this to spread.” 

Paul Coleman, director at the Maryhaven clinic near Columbus, where Mayer sought treatment, said about a quarter of the nearly 130 adolescents currently getting treatment there have used opiates --  something he’s never seen in his 22 years at the center.

“A few years ago if you would have asked me how many young patients I would have using opiates I wouldn't have said 25 percent,” Coleman said. “I would have said none.”

The White House has called prescription drug abuse the nation’s fastest-growing drug problem. The Centers for Disease Control and Prevention has officially dubbed it an epidemic.

'Crisis'
In Ohio and elsewhere, however, the beast has two heads. Opiate abuse, which includes both prescription painkillers and heroin, has become a “crisis of unparalleled proportions,” according to Ohio’s Department of Alcohol and Drug Addiction Services. In 2001, just eight of Ohio’s 88 counties reported a significant number of patients were entering substance abuse treatment for opiate addiction. By the same measure, 85 of Ohio’s 88 counties reported an opiate problem in 2010.

The state has taken action. In 2006, it implemented a system to track prescriptions to help prevent so called “doctor shopping,” where addicts move from one physician to the next looking for prescriptions. Last year, it also passed a law to help fight “pill mills,” unscrupulous storefront clinics known for readily dispensing prescriptions.

Similar measures have been taken across the nation. Combined with new pill formulations that make the medication harder to crush up to snort or shoot, the efforts have curbed supply and abuse. Experts agree this is a positive step. But in Ohio, the crackdown has had unexpected consequences.

The pills have become expensive, and often hard to obtain. Prescription opiates now sell for anywhere from $30 to $80 dollars a pill. A $10 bag of heroin offers a similar or better high.  Unable to find pills, or afford them, addicts go looking for something else to feed the craving. Heroin is cheap, plentiful and potent.

It is also deadly. In fact, the state saw a record number of heroin-related deaths in 2010, which now account for one in every five overdose deaths in the state. Cuyahoga County, home to Cleveland, recorded 106 heroin-related deaths in 2011 -- an increase of nearly 180 percent since 2003, according to the Cuyahoga County Medical Examiner's Office. In early May, Loraine County, Ohio, saw five fatal overdoses in 10 days due to a batch of highly potent, or badly cut, heroin. Experts worry other counties may soon follow suit,and that those dying might be among what the Ohio Department of Alcohol & Drug Addiction Services reports show is the fastest growing demographic of heroin users -- young people between ages 20 and 35.

It’s an addiction that surprises even those who find themselves in its grip.

“If you were to tell me that I was going to use heroin ... the same week in which I used it, I probably would have laughed in your face,” said Tej Yaich, a 20-year-old from Pickerington, Ohio. “That’s something that I would never have done.”

For Yaich, who has been sober for more than a year, addiction started at home. His parents had prescriptions sitting unused in the medicine cabinet. Yaich said he was 15 when he first tried them, crushing them up at night so his parents wouldn’t hear the noise. The experiment became a habit. Then the supply started to dry up.

“One day I went to call my guy that was selling to me and he said he didn’t have pills at that time, but he had something equally as good,” said Yaich. “He said, ‘You’ll like it.’”

What the dealer had was heroin, and he was right. Yaich started by snorting it, then quickly moved on to shooting up. From one bag, he worked himself up to two, then five. At the height of his addiction, he said, he injected up to 25 bags a day.

Yaich’s story is typical of those that Dr. Steven Matson hears from young people coming into his clinic at Nationwide Children’s Hospital in Columbus. Matson, who helped Yaich recover, runs a program there that uses a fairly new medication called buprenorphine, a semi-synthetic opioid that when used correctly helps to curb cravings to assist in recovery.

When Matson started this work three years ago, the young people coming into his clinic were “fringe,” he said. Now they are as often from upscale suburbs of Columbus as from poorer, more rural areas.

“Because of the availability of these drugs now, it is not an usual story that we hear, ‘I went to a party, some friends there were doing heroin, so I shot up,’” he said. “It seems like madness that you would go to a party and never have used anything and then use heroin. But that’s what’s happening with some children.”

Matson’s program also helped Holly Yates recover. She’s been sober since Thanksgiving Day 2010. For more than a year, she’s held a job as a stylist at a local hair salon. She saved up to buy herself a silver Honda Accord. In the back seat are two car seats for her young nephews, who her older brothers now trust her to babysit.

But things can be lonely in Lancaster, where she says nearly everyone her age uses drugs, and many are hooked on heroin.

“It’s just hard being young and staying clean,” Yates said. “I mean this town, it’s just, like, that’s all that’s here.”

“I just want kids my age to know that you don’t have to keep using,” she added. “You can be clean, and you can have a better life.”

By Michelle Andrews
May 29, 2012
What's in a name? That's a question that experts are wrestling with as they prepare to revise the diagnostic manual that spells out the criteria for addiction and other substance-use problems.

The catalyst for this discussion is a set of proposed changes to the Diagnostic and Statistical Manual of Mental Disorders, the reference guide upon which clinicians, researchers, insurers and others rely to identify and classify psychiatric disorders. The revised guide, called DSM-5, will incorporate changes to more than a dozen categories of disorders, including those related to mood, eating and personality, as well as substance use and addiction.

Developed under the auspices of the American Psychiatric Association, the revised manual is scheduled for release in May 2013.

The new guidelines would do away with the diagnostic categories of "substance abuse," which generally is defined by such short-term problems as driving drunk, and "substance dependence," which is chronic and marked by tolerance or withdrawal, in favor of a combined "substance use and addictive disorders" category.

They would also, for the most part, merge the criteria used to diagnose disorders related to the use of alcohol, cigarettes, illicit or prescription drugs and other substances into a single 11-item list of problems typically associated with these disorders. The list covers issues such as being unable to cut down or control the use of that substance and failing to meet obligations at work, school or home.

People would be given a diagnosis based on how many criteria on that list they met: no disorder (0-1), mild disorder (2-3), moderate (4-5) or severe (6 or more).

Supporters say the proposed changes, by creating a category for mild disorders, may make it easier to identify and address drug or alcohol problems before they become serious.

According to the National Institute on Alcohol Abuse and Alcoholism, people are at risk for developing a substance use disorder if their drinking exceeds four drinks on any single day and more than 14 drinks per week for men, and three drinks on any single day and more than seven drinks per week for women.

People who routinely drink heavily at sporting events or regularly get high with friends may be at risk for a substance use disorder, but they generally don't need lengthy treatment to change their ways, experts say. The new DSM guidelines might make it easier for primary-care doctors to be reimbursed by insurers for screening for alcohol and drug problems and conducting short counseling sessions that have been shown to be effective.

The goal is to educate patients about the higher risks they face of, for example, having a car accident or liver problems if they drink, and to motivate them to change, says Keith Humphreys, a psychiatry professor at Stanford University and a former senior drug policy adviser to the Obama administration.

"A lot of times, people aren't aware that their consumption is way higher than average," he says. "If you tell people they drink more than others, they can change and avoid the consequences."

The U.S. Preventive Services Task Force also recommends screening and behavioral counseling to reduce alcohol misuse in adults. Under the federal health law adopted in 2010, it's covered as a free preventive benefit for people in health plans that are new or have changed enough to lose their grandfathered status.

But some addiction experts worry that using the 11-point list of criteria to place substance use disorders on a continuum from mild to severe suggests that there's a natural escalation from non-use to occasional use to risky use to addiction.

"I think that's not consistent with clinical research," says Eric Goplerud, who directs the substance abuse, mental health and criminal justice studies department at NORC, a research organization at the University of Chicago.

It's analogous to depression, he says. "People are sad when bad things happen to them, but not all are on an escalator that will lead them to psychotic depression."

Because the new guidelines use a single spectrum for substance use and addictive disorders, some addiction experts worry that, for example, adolescents who meet the criteria for mild substance use because they've engaged in binge drinking and missed classes because of it within the past 12 months - thereby earning a score of 2 -- might be labeled as having a mild addictive disorder, which in many cases would not be accurate.

Some may resist treatment if they are labeled addicts, says Yifrah Kaminer, a professor of psychiatry and pediatrics at the University of Connecticut Health Center. "Adolescents vehemently don't like stigmatization," he says. "They'll say, 'This treatment is only for addicts, and I don't want to go.' "

Even though the Mental Health Parity and Addiction Equity Act of 2008 requires insurers to cover mental and physical health services equally, "people still have to fight for addiction treatment," says Marvin Seppala, chief medical officer at Hazelden, a Minnesota nonprofit that runs drug and alcohol treatment centers around the country. The parity law doesn't cover group plans at companies with 50 or fewer employees, nor individual health insurance plans.

http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2012/Psychiatric-Manual-Addiction-Diagnosis-Michelle-Andrews-052912.aspx

Urge surfing is a term coined by Alan Marlatt as part of a program of relapse prevention he developed for people recovering from addictions to alcohol and other drugs. It can actually be used to help with any addictive behaviour such as gambling, overeating, inappropriate sex or any other destructive impulses.

http://www.mindfulness.org.au/URGE%20SURFING.htm

ScienceDaily (Jan. 30, 2012) — When it comes to addiction, sex matters. A new brain imaging study by Yale School of Medicine researchers suggests stress robustly activates areas of the brain associated with craving in cocaine-dependent women, while drug cues activate similar brain regions in cocaine-dependent men. The study, expected to be published online Jan. 31 in the American Journal of Psychiatry, suggests men and women with cocaine dependence might benefit more from different treatment options.
 Click link below for more information:
http://www.sciencedaily.com/releases/2012/01/120130131511.htm