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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 mu-opioid 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 (%)
Total 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%)
Race/Ethnicity
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
Vivitrol Doses by Site
Total
(N=399) Tarzana (n=290)
Prototypes (n=39)
BHS (n=70)
Average # of Doses 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
Injections Received
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)
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 ClientsReduced Primary Drug Use
Reduction in Primary Drug Use Days for Treatment (In Past 30 Days)
14.111.7
13.8
2.2 1.3 0.90
5
10
15
20
25
30
All Treatment Clients
OutpatientClients
Residential Clients
Mea
n D
ays
in P
ast 3
0
Admission Discharge
Higher Abstinence Rates among Vivitrol Treatment Clients
Reduction in Primary Drug Use Days for Treatment (In Past 30 Days)
73.7%
81.6%83.1%90.3%
0
25
50
75
100
Outpatient Residential
% A
bstin
ent a
t Dis
char
ge
County Average Vivitrol Treatment Clients
Higher Engagement Rates among Vivitrol Treatment Clients
Engagement Rates of L.A. County Clients vs. Vivitrol Treatment Clients
66.3%
79.6%
64.2%
91.3% 88.2%94.3%
0
25
50
75
100
Overall Outpatient Residential
% E
ngag
emen
t
County Average Vivitrol Treatment Clients
Higher Completion Rates among Vivitrol Treatment Clients
Completion Rates of L.A. County Clients vs. Vivitrol Treatment Clients
33.6% 32.9%39.2%
55.4%46.6%
64.1%
0
25
50
75
100
Overall Outpatient Residential
% C
ompl
eted
County Average 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 non-equivalent 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?
