Prescription Painkiller Addiction on the Main Line

The dissemination of prescription painkillers has spawned a new wave of addiction. As doctors and other healthcare professionals scramble to mitigate the damage in our region, many are succeeding in unexpected ways.

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Dr. Richard DiMonte. (Photo by Jared Castaldi)Now in her 20s, Jessica has been diagnosed with bipolar disorder. Her social circle helped lead her into heroin, and she had a boyfriend with his own set of related problems. By his own admission, her dad spent hundreds of thousands of dollars for services, including multiple stays at residential treatment centers.

Co-occurring disorders are quite common in drug abusers. It’s identifying them, and determining whether they precipitated or resulted from addiction, that’s the real challenge. “Some patients say they have anxiety, but a lot of it may be wrapped up in, ‘Am I going to get help [for the addiction], or will I go into withdrawal?’” says Dr. Laura McNicholas, who’s on the board of the American Academy of Addiction Psychiatry and practices at the Philadelphia VA Medical Center.

Withdrawl is the looming factor in any strategy’s primary goal of weaning a user off the opiate and blocking the desire for it. Among the variety of drugs available for that purpose, Vivitrol is a relative newcomer. Dr. Richard DiMonte prefers it for many of his patients because its extended release “eliminates the need to take a pill everyday”—and, he says, because it works.

From his practice across the street from the Delaware County Courthouse, DiMonte administers Vivitrol by injection once every four weeks. By dispensing with the daily routine, it lessens the chance of relapse caused by missing a dose. Guidelines call for the patient to be detoxed (opiate-free) for at least seven days prior to the initial injection. DiMonte recommends at least a one year treatment to “fix the physical problem” in conjunction with counseling to address the psychosocial aspect of addiction.

Vivitrol is the injectable form of the drug Naltrexone, prescribed for many years to treat alcohol dependence. Though also approved for the treatment of opiate addiction, Naltrexone had been less widely used for that purpose until 2010, when the FDA approved a long-lasting injectable version. It works by blocking sensations experienced by opiate users, even inducing a feeling of sickness—sometimes severe. Clinical trials have been favorable, and drugmaker Alkermes is conducting its own studies to measure longer-term effectiveness. “Most insurances are covering the medication, but out-of-pocket is very expensive,” DiMonte points out.

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