Proven Treatment Is out There for Heroin Addicts. but Good Luck Getting It in Missouri

By Bogan, Jesse | St Louis Post-Dispatch (MO), April 9, 2017 | Go to article overview

Proven Treatment Is out There for Heroin Addicts. but Good Luck Getting It in Missouri


Bogan, Jesse, St Louis Post-Dispatch (MO)


ST. LOUIS * Dante Bonzano had a reputation for being one of the best concrete finishers and bricklayers around. He often worked knee-to-knee with his father, who trained him from a young age to be a devout Jehovah's Witness and work 12-hour days.

The proud father used to say everything the boy touched turned to gold. But that didn't turn out to be true.

By the time he was a grown man, Bonzano was often in reach of a can of Bud or a syringe. His life passed in and out of Missouri's prison system.

Then came an opportunity that eludes most heroin addicts a form of treatment that has been proven effective.

Bonzano was deemed an ideal candidate for a small program in Missouri that treats heroin addicts with a monthly Vivitrol injection as they leave prison and go back to their communities. At $1,000 a pop, the drug is supposed to shield the brain from getting high.

In other words, it works on the premise that the best way to fight drug addiction is with more drugs.

That flies in the face of popular notions about kicking the habit through sheer willpower. For decades, the prevailing response to opioid dependency has largely been the same as for alcohol and cocaine addiction: abstinence, followed by support, such as a 12-step program.

But a commanding body of research suggests that's not working for the tens of thousands of people who die each year from the opioid epidemic, including hundreds in the St. Louis region.

"Detox is not treatment," said Rachel Winograd, director of a $20 million federal grant in Missouri aimed at improving response efforts between emergency rooms, drug treatment centers, mental health clinics, primary care doctors and emergency responders. "We are setting people up to fail if we let them out the door with nothing to help keep their cravings at bay."

What does work, according to evidence-based research, is medication-assisted treatment. The most well-known methadone isn't new.

Often dispersed on the fringes of society, methadone has been used since the 1960s, and was pushed by the government to treat heroin addicts coming back from the Vietnam War. A correct dosage stimulates opioid receptors in the brain of severe addicts, limiting withdrawal symptoms and the urge to use.

More than 70 percent of people respond to treatment a figure that dwarfs recovery rates for those without medical support.

And yet medication-assisted treatment is missing nearly 80 percent of opioid addicts.

Some don't think they need help. But public health experts say the shortfall is also caused by a dire lack of coordination in the system. They say there isn't a standardized method of care for the growing crisis. There's still confusion about what treatment even is and how long it should last.

If addicts do want help, they often aren't aware of the most effective options, nor can they immediately get access to care. On any given day in Missouri, 2,500 people rich and poor are on a waiting list for drug treatment.

"Someone who is put on a wait list today may be in jail or in an emergency room tomorrow," said Mark Stringer, director of the Missouri Department of Mental Health. "Every single name on a waiting list is a potential tragedy."

Part of the problem, experts say, is that too few medical treatment options are on the table. Methadone and naltrexone, which comes in a daily pill and the extended-release Vivitrol shot, are two of only three drugs approved by the FDA to treat opioid addiction. The other is buprenorphine.

Access to the three drugs is severely limited by an addict's ability to pay, with state and federal funding running far short of the need for subsidized treatment. But even for patients with financial means, finding a doctor or program to administer medication-assisted treatment is difficult.

Few physicians prescribe medicine for addicts and many are apprehensive to get involved. Patients with substance-use disorders often have co-occurring conditions. …

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