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Results of the Vivitrol Pilot in Los Angeles County Presented by: Desiree A. Crevecoeur-MacPhail, Ph.D. Research Psychologist, UCLA ISAP Background What is Vivitrol? • Injectable extended release naltrexone was FDA approved in 2006, for the treatment of alcoholism – In 2011, the FDA approved Vivitrol for the treatment of opiate addiction. • An opioid receptor antagonist, that blocks the muopioid receptors in the brain – Mu-opioid receptors are responsible for the “high” or “buzz” individuals feel when alcohol is consumed or opiates are used. Benefits of Vivitrol • Reduces the number of risky and heavy drinking days (Garbutt et al., 2005; Lee et al., 2010; Manelli, 2007) • Improves individuals’ quality of life (Pettinati et al., 2009; Schmitz et al., 2001). Los Angeles County Vivitrol Pilot Project Evaluation Questions • Do LA County SAPC clients remain on Vivitrol beyond the 1st dose? – Does medication affect client outcomes? • • Length of stay, reported use of alcohol, retention and engagement Does staff knowledge and attitudes toward medication assisted treatment improve at 4 month follow-up compared to baseline, as a result of trainings? Evaluation Design • The three medication hubs: – Tarzana Treatment Center (main hub) – Behavioral Health Services – Prototypes. • Selection criteria: – Infrastructure (staff, examination room, refrigerated and locked location for medication storage) to administer medications – Long-standing histories of providing quality substance abuse treatment to a broad range of clients Data Collection • Treatment Outcome Data – LACPRS • Patient Response to Vivitrol – Medically Assisted Treatment Survey (MATS) – Urge to Drink Scale (UDS) • Counselors’ Attitude – Counselor Attitude Survey Results & Findings Improved Counselor Attitudes • Counselor attitudes improved over the course of the project and many who initially reported neutral or negative attitudes towards medication-assisted treatment in general or Vivitrol in particular, reported positive attitudes on the follow-up survey. Participant Characteristics Overall N (%) Detoxification Participants n (%) Treatment Participants n (%) 387 (100%) 96 (24.8%) 233 (60.2%) Male 195 (50.4%) 65 (67.7%) 101 (43.3%) Female 192 (49.6%) 31 (32.3% 132 (56.7%) White 205 (53%) 65 (67.7%) 103 (44.2%) Hispanic/Latino 124 (32%) 22 (22.9%) 90 (38.6%) African American 38 (9.8%) 2 (2.1%) 30 (12.9%) Asian American/Pacific Islander 5 (1.3%) 4 (2.0%) 0 (0.0% American Indian/Alaskan Native 3 (0.8%) 1 (1.0%) 2 (0.9%) Other 12 (3.1%) 2 (2.1%) 8 (3.4%) Mean Age 38.0 years 39.8 years 27.9 years Total Race/Ethnicity Vivitrol Doses by Site Total (N=399) Tarzana (n=290) Prototypes (n=39) BHS (n=70) 2.49 + 2.022 2.47 + 2.123 2.74 + 1.831 2.74 + 1.576 Mode 1 1 2 1 Minimum # of Doses 1 1 1 1 Maximum # of Doses 12 12 7 7 One Dose Only, % (n) 41.1% (164) 45.5% (132) 28.2% (11) 30.0% (21) Two Doses Only, % (n) 22.6% (90) 22.1% (64) 30.8% (12) 20.0% (14) Three Doses Only, % (n) 12.3% (49) 11.4% (33) 15.4% (6) 13.3% (10) Four or More Doses, % (n) 24.0% (96) 21.0% (61) 25.6% (10) 36.7% (26) Average # of Doses Injections Received Reduced Urge to Drink Based on the Urge to Drink Scale, which is scored from 0 to 30. Limited Side Effects Proportion Reporting Side Effect for Weeks 1 – 4 After First Dose Treatment Clients Reduced Primary Drug Use Reduction in Primary Drug Use Days for Treatment (In Past 30 Days) Mean Days in Past 30 30 25 20 15 14.1 13.8 11.7 10 5 2.2 1.3 0.9 Outpatient Clients Residential Clients 0 All Treatment Clients Admission Discharge Higher Abstinence Rates among Vivitrol Treatment Clients Reduction in Primary Drug Use Days for Treatment (In Past 30 Days) 100 90.3% % Abstinent at Discharge 83.1% 75 81.6% 73.7% 50 25 0 Outpatient County Average Residential Vivitrol Treatment Clients Higher Engagement Rates among Vivitrol Treatment Clients Engagement Rates of L.A. County Clients vs. Vivitrol Treatment Clients 100 94.3% 91.3% 88.2% % Engagement 79.6% 75 66.3% 64.2% 50 25 0 Overall Outpatient County Average Residential Vivitrol Treatment Clients Higher Completion Rates among Vivitrol Treatment Clients Completion Rates of L.A. County Clients vs. Vivitrol Treatment Clients 100 % Completed 75 64.1% 55.4% 46.6% 50 32.9% 33.6% 39.2% 25 0 Overall County Average Outpatient Residential Vivitrol Treatment Clients Success Stories 45-year-old, Latina female who has been trying to stop drinking for 15 years. She has been in “over 20 detoxes” and this is her fifth time in residential treatment. This is the first time, thanks to Vivitrol, that she has lost the craving for alcohol since she began drinking as an adolescent. 52-year-old, Caucasian male who has been drinking since 14 years of age. He tried to stop drinking for 25 years on his own or through 12-step programs. He never achieved more than 3-4 months of sobriety at a time. This is his 2nd Tx program; in his first program he lasted two months – “thinking about drinking every single day. I couldn’t get it out of my head, so I left.” Currently, he has received 2 Vivitrol injections and has “been able to concentrate on the counseling work” since the third day after his first injection. He was on a pass last week and passed the liquor store where he has been “keeping a tab” for 15 years and “didn’t even realize I went by it until I was three blocks away. Vivitrol is fantastic!” 36-year-old, American Indian male with a 20-year history of alcohol and methamphetamine abuse and a co occurring diagnosis of bipolar disorder. He has been in treatment 4 times since he began trying to stop using 8 years ago. While he did manage to stop using meth 4 years ago, his daily drinking has been steadily getting worse over the last two years, most often leading to blackouts. He has received 4 Vivitrol injections so far and says he has not had any urges to drink since “a couple of days after the first shot.” Conclusions • In this pilot, Vivitrol – Increased the number of clients who complete treatment in detoxification, outpatient counseling and residential treatment programs. – Decreasing substance use in outpatient counseling and residential treatment – Increasing treatment engagement (outpatient and residential) and treatment continuance for residential treatment. Next Steps • Assess these findings against a nonequivalent comparison group – Look at outcomes of clients with similar background and compare to the Vivitrol group • Assess urges once Vivitrol is no longer being taken – short-term follow-up – Examine how clients fare in treatment once they are no longer taking the medication • Address Board Amendments Los Angeles County Board of Supervisors Amendments • SAPC to report in 90 days on: 1. Policy changes needed to expand the availability of Vivitrol (Medi-Cal) 2. Recommendations on how Vivitrol can be purchased at the most affordable price • SAPC to report in 12 Months on: 1. The efficacy of Vivitrol and MAT as cost effective measures to improve outcomes 2. Recommendations for use in high risk, high consequence populations Questions? Thank You! Desiree A. Crevecoeur-MacPhail, Ph.D. (310) 267-5207 email: [email protected]