Springfield clinic sees cautious hope in fight against heroin

In the midst of an out-of-control heroin-fentanyl epidemic that killed twice as many as Clark Countians last year as the year before, McKinley Hall CEO Wendy Doolittle isn’t beginning to claim victory.

But she does say that the “huge difference” she’s seen during the past year in clients treated with Vivitrol — a drug that prevents recovering addicts from experiencing a high — is reason for hope.

In 2014 , 37 people died of unintentional drug deaths. That jumped to 72 last year. Through May of this year, 28 people died from overdoses, according to the Clark County Coroner’s Office.

Doolittle describes the onslaught as unprecedented, surpassing even the crack epidemic.

“Nothing has compared with the level of sickness and the number of people this has impacted,” she said, a reality that has “changed the face” of McKinley Hall.

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Alyssa Boian, a longtime addict who said she resisted trying Vivitrol, said it’s made a huge difference in her life.

“The last five (years) were the worst — I relapsed all the time,” Boian said. “I have nine months clean. I’ve done so much more in these last nine months than I have in the past five years.”

‘Another addiction’

Because medication is required to wean addicts off opioids, McKinley Hall established a medical element to its treatment program 10 years ago.

Three years ago, with heroin deaths rising, it established its present, expanded Medication Assisted Treatment program and hired Dr. Narinder Saini as medical director. A former cardiologist, he went back for training in addiction medicine.

With the help of grants and reimbursements, Saini first began prescribing Suboxone, an often used methadone relative, to heroin addicts.

Because Suboxone is itself a form of opium and is — like other opioids — taken daily, Saini considers it “another addiction” for his patients and not the long-term answer.

It’s a comment that resonates with recovering addict Erin Conwell.

“You realize you need it almost like you need the drug,” she said. “When I forgot to take it, I started freaking out.”

Because Suboxone is self-administered by some clients, it also has the potential for abuse. If they skip days and then take it, it can produce a modest high, which leads to a second drawback: it can be sold on the street to other opium addicts.

For those reasons, McKinley Hall takes steps to closely supervise those at risk for those behaviors.

Neither Saini nor Doolittle discounts Suboxone’s importance. It clearly has saved lives of those who have been taking it as deadlier forms of heroin have come in waves, they said.

But Doolittle said it’s best seen as “a short-term bridge” on the longer road to recovery.

So during the past year McKinley has started using the drug Vivitrol on the far side of that bridge.

‘I knew I couldn’t get high’

A longer-acting relative of Naloxone or Narcan, the drug used to rescue addicts from an overdose, Vivitrol attaches to receptors in the brain and prevents opioids from bonding with them to create the experience of a high.

These receptors “are where the whole thing is going on” with addicts, Saini said. Due to their genes, addicts have lower naturally occurring levels of the chemical dopamine associated with life’s “natural” highs.

When exposed to drugs that elevate those levels, “the brain starts to salivate,” he said.

That same area of the brain is involved not only in drug addictions, Saini said, but in gambling and sex addictions — and the dynamic involved in relapse also is at work in patients who fail to keep up with their treatment regimens for Type 1 diabetes, high blood pressure and asthma.

“I’m convinced it’s genetic,” he said.

Although it’s available in pill form for other uses, McKinley Hall administers Vivitrol by injection in a shot that’s effective for about 30 days.

“That’s the main thing in the beginning,” said Jody Arnold, the first McKinley hall client to use Vivitrol. “Instantly I knew I couldn’t get high.”

She and others said that inability provides people in recovery peace of mind for a time because controlling cravings on their own is such a challenge.

In what may seem strange to non-users, being locked up in jail provided the same kind of peace of mind to recovering addict Boian when she withdrew from illegally obtained Suboxone.

“It wasn’t too bad,” she said, “because there was nothing I could do.”

McKinley Hall began in February to offer Vivitrol shots to inmates from the Clark County Jail who were placed on probation through the Clark County Municipal Court.

“Once they are identified and meet criteria,” Doolittle said, “our jail therapist completes an assessment and the jail nursing staff order labs.”

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After Saini reviews the labs and orders Vivitrol, the judge orders the release and a probation officer who works out of McKinley Hall transports the patient for their first injection.

The direct transportation from jail to McKinley Hall eliminates the opportunity of use upon release, which is not only good for the sake of recovery but saves addicts from the increased risk of death that comes with reuse immediately after withdrawal.

Active, productive life

The ramping up of the Vivitrol program has led to a dramatic increase in the number of clients taking Vivitrol and reduction in those taking Suboxone.

In January, 52 percent of people on medications through McKinley Hall were taking Suboxone and 20 percent Vivitrol. By July, the numbers were nearly reversed, with 48 percent taking Vivitrol and 27 percent taking Suboxone. At present, 45 patients are on Vivitrol and 25 on Suboxone.

The switch has made a huge difference in client recovery, Doolittle said, and she describes Vivitrol as the withdrawal tool “that allows you to live an active, productive life.”

The cost of Vivitrol injections, which is covered by Medicaid and most insurances, is about $1,000 a month. With the Vivitrol program now in full swing, Doolittle remembered the frustrating time when she worried whether it would get off the ground

“We couldn’t get folks to use it,” she said, and the reason was simple.

“One hundred percent of the people who walk in the door are afraid of withdrawal,” so withdrawing with the goal of taking a new drug no one was familiar with represented a huge step.

In the face of his patients’ worries that it might cause headaches or other issues that would increase the chance of relapse, Saini himself took the pill form of the drug for six weeks so he could address from personal experience concerns about Vivitrol’s possible side effects.

Then, not quite two years ago, Arnold became the first patient, whose experience helped to spread the news about Vivitrol through the addict community and that has given it traction.

As pleased as he is with what he sees as the progress made through McKinley’s Hall Medication Assisted Treatment program, Saini says the medical side is only 25 to 30 percent of the rehabilitation picture. The remainder involves the work therapists do as they help recovering addicts confront the wreckage of their lives and try to stay clean as they rebuild them.

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