Pubdate: 24 Jan 2005
Source: Philadelphia Inquirer
Author: Stacey Burling, Inquirer Staff Writer
Copyright: 2005 Philadelphia Inquirer
BACKING LITTLE-USED DRUGS FOR ADDICTS-NALTREXONE
When criminals who are addicted to heroin are sent to Gaudenzia Incorporated for rehabilitation, they get a big helping of psychosocial treatment. But
there's no mention of naltrexone, a medication that totally blocks the
effect of opiates such as heroin and OxyContin.
Gaudenzia's approach is typical, and Charles O'Brien, a University of
Pennsylvania psychiatrist who has been studying naltrexone since 1973,
think s that's a problem. He's so frustrated by the drug's meager usage 20
years after its FDA approval that he's suggesting an unusual way to get
more addicts to try it: make it a provision of their probation or parole.
"We have a solution that we're not using," said O'Brien, who estimates
that no more than 10 percent of the country's one million heroin addicts
have tried naltrexone.
He organized a symposium at Penn this month to explore the legal and
ethical implications of his idea. To sway more opinions, a transcript of
the meeting will be sent to judges and probation and parole officers.
The practical aspects of requiring criminals to take naltrexone - now a
pill taken at least twice a week - will become less daunting within the
year if, as O'Brien predicts, the FDA approves a new injectable form that
lasts a month.
A six-month pilot study at Penn in which Philadelphia probationers and
parolees on naltrexone repeatedly gave urine samples found that they
tested positive for opiates 8 percent of the time. Addicts receiving only
standard treatment tested positive 30 percent of the time. The
reincarceration rate was 26 percent for the naltrexone group and 56
percent for the others. Fifty-one volunteers participated.
Penn is now doing a larger study of the drug in this population and plans
to switch to the injectable form in September.
Larry Frankel, legislative director of the American Civil Liberties Union
of Pennsylvania, said requiring a drug as a condition of release, even if
people can choose prison instead, is a "fairly scary precedent."
"We tend to, as a society, say the government cannot force you to take
medication," he said.
But Darrell Stevens, a Superior Court judge in Chico, California, has been
requiring people to take the drug since 1996, first in alcohol cases and
more recently in the county's drug court, without any problems. He tried
it, he said, because other measures weren't working. "I kept seeing the
same people coming before me all the time." He now has a "raft" of letters
from offenders thanking him and describing how their lives have turned
In Chico, offenders ordered to take th e drug, always with a doctor's
concurrence, must take pills while a doctor or pharmacist watches. All of
the county's pharmacies participate in the program, Stevens said.
Judge Louis J. Presenza, who runs Philadelphia's drug court and is
cooperating with Penn's study, is hopeful about naltrexone, though most of
the people who come before him use cocaine and marijuana. "We have to try something different," he said. "If naltrexone is available, then people
should have the option to use it."
O'Brien said most criminal justice officials are wary of medications for
addiction. "They tend to take a p hilosophy which is st rongly and
militantly drug-free, which would be great if it worked, but it doesn't."
Studies show that 85 percent of addicts return to drug use within a year
of release from prison, said Douglas Marlowe, director of l aw and ethics
research at Penn's Treatment Research Institute. Treatment both in and out
of prison reduces by 10 percent to 20 percent the chances that addicts
will use drugs or get arrested again, according to different studies.
Even though it has proven effective, judges and others in the criminal
justice system dislike methadone, the most widely used drug for opiate
addiction, because it is addictive, O'Brien said.
Naltrexone's big advantage is that it is not addictive or even
pleasurable, he said. O'Brien likened the drug, approved for treatment of
heroin addiction in 1985 and alcoholism in 1995, to a "chemical chastity
Unfortunately, that's also its bigges t drawback. "The problem with
naltrexone is it w orks too well," Marlowe said. "Clients don't want a drug
that won't let them get high."
Naltrexone has worked for highly motivated addicts such as doctors and
nurses who have a profession to lose, O'Brien said. But others quickly
abandon it when they want to get high.
O'Brien said a longer-acting version of naltrexone will help with the
compliance problem. Alkermes, a Cambridge, Mass., company, plans to seek
FDA approval for the injectable form for alcoholics, but doctors could
then use it off-label for opiates.
Naltrexone does a better job of blocking heroin's effect than alcohol's,
but it seems especially good at blunting cravings and the euphoria that
people with hereditary alcoholism feel when they drink, O'Brien said. A
Penn study of the 30-day version in alcoholics found it reduced heavy
drinking by 25 percent.
There are 14,240 people on parole in New Jersey and 28,000 on
state- supervised parole or probation in Pennsylvania. An additional
213,000 people in Pennsylvania and 86,400 in New Jersey are on county
Official estimates of the New Jersey and Pennsylvania state prisoners with
drug problems range from 55 percent to 70 percent.
Michael Briscoe, a supervisor in Philadelphia's adult probation department, said most probation officers are indeed opposed to methadone
treatment . "We see drug-free as the ultimate prize," he said.
But he encouraged staff members to attend the Penn symposium and has
helped Penn researchers find addicts willing to try naltrexone. "Because
it has a therapy component, we're more open to it," he said, "also because
of the fact that addicts don't get high from it. It just seems like a more
viable option to me than methadone."
There is no legal reason not to make naltrexone use a condition of
probation or parole, said Richard Bonnie, director of the University of
Virginia's Institute of Law, Psychiatry and Public Policy. "The important
thing is that offenders have a choice, even if the alternative is jail."
Presenza said some addicts do, in fact, prefer prison to probation with
lots of conditions.
Barry Savitz, a former Philadelphia assistant health commissioner who is
now a consultant to Philadelphia Health Management Corporation warned againstexpecting too much from any drug treatment alone. "If it were not for the
drug abuse," he said, "these would not be model citizens."
Contact staff writer Stacey Burling at 215-854-4944 or
Naltrexone (Alternative Treatment)
Coming Soon: More on Naltrexone
I would appreciate an article from anyone who has taken it for addiction. What amount did you take and was it a success / failure in your opinion? How about it -- you can remain anonymous if you prefer-I just want your experience. If there are any Doctors that have any experience with p rescribing it and would like to send me an article -- I would love your point-of-view and experience with the medication.
Modified: July 2, 2005