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Pubdate: 24 Jan 2005
Source: Philadelphia Inquirer
Author: Stacey Burling, Inquirer Staff Writer
Copyright: 2005 Philadelphia Inquirer


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.   

Thank You.

Modified:  July 2, 2005