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 EffectsProportion 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 Da

ys in

Pas

t 30

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 Disc

harg

e

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 thefirst time, thanks to Vivitrol, that she has lost the craving foralcohol since she began drinking as an adolescent.

52-year-old, Caucasian male who has been drinkingsince 14 years of age. He tried to stop drinking for 25years on his own or through 12-step programs. He neverachieved more than 3-4 months of sobriety at a time. Thisis his 2nd Tx program; in his first program he lasted twomonths – “thinking about drinking every single day. Icouldn’t get it out of my head, so I left.” Currently, he hasreceived 2 Vivitrol injections and has “been able toconcentrate on the counseling work” since the third day after his first injection. He was on a pass last week andpassed the liquor store where he has been “keeping a tab”for 15 years and “didn’t even realize I went by it until I wasthree blocks away. Vivitrol is fantastic!”

36-year-old, American Indian male with a 20-year historyof alcohol and methamphetamine abuse and a cooccurring diagnosis of bipolar disorder. He has been intreatment 4 times since he began trying to stop using 8 yearsago. While he did manage to stop using meth 4 years ago,his daily drinking has been steadily getting worse over the lasttwo years, most often leading to blackouts. He has received 4Vivitrol injections so far and says he has not had any urges todrink 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?

Thank You!

Desiree A. Crevecoeur-MacPhail, Ph.D.(310) 267-5207

email: desireec@ucla.edu