August 28, 2014

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Courts use drug injections to fight heroin

Judge Robert Peeler tries a case involving heroin abuse in Warren County Common Pleas Court, April 15 in Lebanon. Peeler is among a growing number of judges and corrections officials across the country trying to combat the fast-growing national heroin problem by fighting heroin needles with treatment needles. (AP Photo/Al Behrman)

Judge Robert Peeler tries a case involving heroin abuse in Warren County Common Pleas Court, April 15 in Lebanon. Peeler is among a growing number of judges and corrections officials across the country trying to combat the fast-growing national heroin problem by fighting heroin needles with treatment needles. (AP Photo/Al Behrman)

LEBANON — The twice-arrested heroin user listened nervously as the judge reviewed her record, then offered a deal he thinks could save her life.

“You’re not a criminal, you’re an addict,” Judge Robert Peeler told Cynthia Fugate. “Something is driving you to use heroin that is beyond your control. Is that fair to say?”

“Yes, sir,” she replied quietly.

Peeler, a common pleas court judge in southwest Ohio’s Warren County, is among a growing number of judges and corrections officials across the country trying to combat the fast-growing national heroin problem by fighting heroin needles with treatment needles. Peeler told Fugate he could order monthly injections of the opiate-blocking drug Vivitrol if she were willing.

Twice-arrested heroin user Cynthia Fugate stands before Judge Robert Peeler April 15. (AP Photo/Al Behrman)

Twice-arrested heroin user Cynthia Fugate stands before Judge Robert Peeler April 15. (AP Photo/Al Behrman)

“I’m 30 years old. I’ve overdosed four times,” Fugate said, her voice quavering. “I want to be clean. I really do.”

The shots, the judge said, could keep Fugate from “winding up in a body bag.”

Peeler began researching the drug treatment shots last year after a young woman died of a heroin overdose, at least the third heroin user who had stood before him in his courtroom who later died. Nationally, overdose deaths have risen 45 percent from 2006 to 2010. In Ohio, 680 people died of heroin overdoses in 2012, up 60 percent from the previous year.

Vivitrol has its skeptics, with some questioning whether it’s effective enough to warrant the time and expense — shots can cost about $1,000 each — and suggesting it’s a trendy, under-researched attempt at a quick fix. Sheriff Richard Jones in neighboring Butler County has called Vivitrol in jails “a waste of money,” citing an earlier pilot program in Warren County in which only three of 12 subjects completed the program and stayed off drugs.

Peeler is among those who say the high toll of heroin-related deaths, crime and prison recidivism make it worth trying.

“To sit back and keep doing what we’ve been doing just isn’t going to get it,” Peeler said. “I want to stop people from dying.”

The Warren County program is getting some $800,000 in state funding help for Vivitrol, and programs also are underway in dozens of other courts, jails and prisons in at least 21 states, from Cape Cod, Mass., to Lane County, Ore. The programs are usually funded with grants, getting some help from drugmaker donations and discounts, and insurance usually will cover some shots.

Vivitrol, made by Alkermes PLC of Ireland, had been used for alcoholism. But after a Russian study showed it could be effective for users of heroin, morphine and other opiate drugs with once-monthly injections, it was approved by the U.S. Food and Drug Administration in late 2010.

Vivitrol uses naltrexone, an opioid receptor antagonist, to block heroin’s effects on the brain. Unlike the widely used methadone treatment, it doesn’t require clinic visits and daily doses and is unlikely to lead to trading one dependency for another, as can happen with other treatments, advocates say. Effective for a month, it eases the daily temptation of people struggling to stay off heroin.

Because Vivitrol is long lasting, it has special importance for former heroin users leaving incarceration, said Mady Chalk, a former federal official on substance abuse who is now with Philadelphia’s Treatment Research Institute.

“Patients return to their community having been detoxed, their systems have been emptied of the drugs; they return to environments that trigger all the things that one would expect,” Chalk said. Many are unable to resist the urge to reuse heroin and don’t realize they can’t tolerate as strong a dose as before.

“The body simply can’t handle it, and they die,” Chalk said.

Giving users an injection before they leave custody provides a month’s buffer to begin post-release counseling and to focus on rebuilding their lives.

Dr. Mark Willenbring, a former National Institute on Alcohol Abuse and Alcoholism official who founded Alltyr addiction treatment center in St. Paul, Minn., thinks there is too little evidence of success to consider Vivitrol a panacea. “It’s not a wonder drug,” Willenbring recently told the Alcoholism & Drug Abuse Weekly.

Peeler doesn’t order shots for anyone who doesn’t want them. In his courtroom the same day as Fugate, a male drug defendant declined, saying he believed the shots were dangerous — there are potential risks including liver damage and suicidal depression — and he didn’t want to go through the therapy and probation requirements of the sentencing deal that potentially allows drug defendants to avoid a conviction on their record.

But Sherry Moore believes the shots saved her.

Not long after completing a nine-month sentence for heroin possession, she began using again. She told her probation officer she didn’t know what to do, that she had already been through treatments.

“I’m like, ‘I’m a mess,’” she recounted. “None of it worked for me.”

The officer asked if she wanted to try Vivitrol. After a year of monthly injections, she said she’s been drug-free since late 2012.

She and other Vivitrol advocates emphasize that counseling and a strong will to overcome addiction are needed, too. Moore, 53, also credits her return to church.

“I think God helped me with it,” she said. “I think I would have died.”

  • oldruss

    These addicts are in front of a judge for a reason. They were all tried and convicted or plead guilty to one or more CRIMINAL offenses. Deal with that first, then, as a condition of parole, IF THEY PAY FOR IT, order the drug injections to wean them off of whatever opiates they’re using.

    • golfingirl

      Worth a try.

      But still requires intensive counseling and a desire to remain sober.

      • jz

        Best counseling is the one for free. AAor NA which is a sober network of support.

        • golfingirl

          I agree. My husband has been sober for 27 years, all through AA.

          No dues, no fees, no government program. Just a desire to live a better life.

  • Phil Blank

    Didn’t they used to use something else that you got from a clinic?

    Anyways, found this on Claims Journal.
    Deaths Due to Painkillers Higher Than Heroin, Cocaine Combined

    June 18, 2014

    The number of deaths involving commonly prescribed painkillers is higher than the number of deaths by overdose from heroin and cocaine combined, according to researchers at McGill University. In a first-of-its-kind review of existing research, the McGill team has put the spotlight on a major public health problem: the dramatic increase in deaths due to prescribed painkillers, which were involved in more than 16,000 deaths in 2010 in the U.S. alone. Currently, the US and Canada rank #1 and #2 in per capita opioid consumption.

    http://www.claimsjournal.com/news/national/2009/03/24/98999.htm

    • golfingirl

      That’s what happens when you combine prescription drugs with alcohol.

      Patients are told not to do it, labels are attached to their prescription bottles, but they still drink on top of the medicine.

      Half of these deaths are as much an alcohol issue, as a prescription drug issue.

      • Phil Blank

        You stopped at alcohol and tripped.
        IF you read further, it goes on to say: ““We found little evidence that Internet sales of pharmaceuticals and errors by doctors and patients – factors commonly cited in the media – have played a significant role,” Prof. King adds.”.

  • Phil Blank

    UK & Europe has the same problem as the America’s.
    Found this yesterday on Euro News, the who page is covered in drug related issues and the same story, the war on drugs doesn’t work.
    http://www.euronews.com/tag/europeans-and-drugs

    • Mark B

      the “War On Drugs” is just a fund raiser for Police and corrections facilities

  • TRB SR.

    Americans spend an estimated 65 Billion a year on illegal drugs. The drug rehab industry rakes in another 34 Billion a year (approximately 80% of that comes from public funding).The DEA has a 2014 budget of 2.8 Billion. IMHO, the illegal drug industry is a very lucrative endeavor no matter what side of it one may be on. Good luck to anyone who gets addicted, because many entities profit off of you whether it be coming or going.

  • SniperFire

    ‘You’re not a criminal, you’re an addict,” Judge Robert Peeler told Cynthia Fugate. ‘

    Heroin is illegal to possess and use. She IS a criminal, and the judge is an idiot.

    • Phil Blank

      Hou said it yourself.
      “Heroin is illegal to possess and use.”
      That makes her a criminal.