LADUE • Stephanie Willis never wanted to quit.
The voices, as she calls them, were too loud.
You’re stressed, you deserve it. Nobody will know.
Three years into her heroin addiction, the state had taken her son away. Her parents, expecting a fatal overdose, started shopping for her burial site. Still, each of the 14 times she entered rehab, the chatter continued.
Your life isn’t that bad. You don’t need to be here. Everyone else has a problem, not you.
“I would want to want to stop, but things just never seemed that bad to me,” said Stephanie, 25, of Ladue.
Then, about two years ago, Stephanie found something that she says silenced the noise: a drug called Vivitrol.
Now, the same drug Stephanie credits with her recovery is being used to treat addicts upon their release from at least one Missouri prison, as well as those in St. Louis’ drug court. It also has grabbed the attention of the federal drug czar, Gil Kerlikowske, who heard Stephanie’s story in August when he visited the south St. Louis clinic where she goes for treatment.
Kerlikowske, who heads the White House Office of National Drug Control Policy, told the Post-Dispatch that medications such as Vivitrol are the future of addiction treatment, which, until this point, has relied almost solely on therapy-based models or addicting medications.
Vivitrol is a monthly intramuscular injection that blocks the brain’s ability to get high or drunk.
So, should a heroin addict shoot up, he or she will feel nothing. A prescription opiate addict won’t get high. An alcoholic will lose muscle coordination without the pleasure of intoxication.
“Vivitrol silenced (the voices) long enough to the point where you can hear the message they’re trying to give you,” Stephanie recalled of her first few moments of clarity during therapy.
But the drug has its critics. Research on long-term effects is still developing, and its cost puts it out of reach for most people without private or government insurance.
And its use in mainstream addiction treatment has much greater challenges, according to one of its biggest proponents, Percy Menzies, who runs the locally based Assisted Recovery Centers of America, where Stephanie continues her therapy.
To some doctors, treating chemical addiction with another chemical is taboo, Menzies said. But he’s convinced the drug can be a critical weapon in the fight against addiction.
“As long as we keep this on the outside of the mainstream of addiction treatment,” he said, “we’re not going to make any progress in this field.”
‘DON’T WALK, RUN’
Don and Marcia Willis adopted Stephanie when she was 10 weeks old. They enrolled her in Ladue schools, where, she says, she was taunted relentlessly. By fifth grade, Stephanie told a counselor that she wanted to die. She was hospitalized for being suicidal at the age of 12. The roots of her emotional problems were difficult to diagnose, although her birth mother had a history of mental illness.
Stephanie started cutting herself with scissors and knives.
She moved in and out of psychiatric centers, which introduced her to prescription medications. At an alternative high school, she started taking pills to get high.
Eventually, Stephanie enrolled at Southeast Missouri State University. But she didn’t stay long.
“She made it back to St. Louis before we did,” Don Willis, 68, recalled.
The $120,000 her parents had saved for college went instead to treatment centers, lawyers and medical costs as she progressed from prescription pills to heroin.
Soon, Stephanie was a criminal, arrested for stealing. Possession. Stealing. Possession.
Stephanie said the fatal overdose of her best friend further fueled her heroin addiction. Hospitalized after a car accident, a doctor told her she was pregnant.
She gave birth to her son Christopher in October 2008. Doctors gave mother and son methadone to relieve the effects of heroin addiction. The boy spent the first month of his life hospitalized. The state took custody.
Stephanie also learned she had pancreatitis, which led to a cycle of rehab, hospitalization and relapse after being treated with opiates.
Meanwhile, her parents became Christopher’s legal guardians.
Homeless, alone and freezing while trying to sleep on a bench at a bus stop one night, Stephanie said she had had enough.
She heard about Menzies’ facility through the grapevine. She called her dad and told him, “I found the perfect place.” But she needed $5,000 to pay for it.
Marcia Willis was skeptical, so she asked around about it.
“The advice I got was, ‘Don’t walk, run,’” Marcia Willis, 64, said.
HOW IT WORKS
The pill form of Vivitrol is called Naltrexone.
The federal government spent millions to develop Naltrexone about 30 years ago to prevent heroin relapses. The FDA approved it to treat heroin addiction in 1984, and for alcoholism in 1994.
But the pill required a measure of discipline, as it needed to be taken daily. By the 1990s, a federal nonprofit agency, the National Institute on Drug Abuse, funded research to develop an injectable form of the drug.
A company ultimately developed Vivitrol and was later bought by the drug’s current manufacturer, Alkermes. The FDA approved its use in treating alcoholics in 2006, and followed with approval for opiate addiction in 2010.
The agency relied heavily on a Russian study, which showed 36 percent of Vivitrol patients stayed in treatment drug-free for six months, compared to 23 percent of those not on the drug, said David McCann, of the National Institute on Drug Abuse’s Division of Pharmacotherapies and Medical Consequences.
But the research is “spotty” and has not included participants from the upper and middle classes, says John Schwarzlose, head of the Betty Ford Center in California.
“The pharmaceutical company will have you believe it is the cure for alcoholism,” Schwarzlose wrote in an emailed response to questions from the Post-Dispatch. “But recovery is learning to live without mood-altering chemicals.”
The Betty Ford Center refers patients only for 90-day use of Vivitrol, he said.
At ARCA, Menzies’ clinic, patients stay on the medication for a minimum of six months. And despite skepticism from treatment providers such as the Betty Ford Center, Menzies’ business is booming.
Menzies, a trained pharmacist, opened his first inpatient clinic earlier this year, a 25-bed wing inside the Metropolitan St. Louis Psychiatric Center. His Chesterfield and south St. Louis locations are outpatient centers, offering therapy and medication.
Six months with ARCA costs about $8,000. Inpatient care ranges from $500 to $600 per night, with an average 10-day stay. Less than 10 percent of clients that complete the program return, said Menzies, who’s also forming a nonprofit organization to help offset the costs of his program.
Addicts eventually develop the need for alcohol or opiates to get surges of dopamine, the body’s pleasure hormone, so they can get high or even feel normal. Vivitrol works to block endorphins, which stimulate surges of dopamine.
But an addict’s “hijacked” brain, as Menzies calls it, can recover. Vivitrol gives the brain a chance to reboot by blocking endorphins altogether.
Click the image below to learn more about how Vivitrol impacts the brain to curb addiction.
This is a critical time in an addict’s recovery, and the prescription label warns of suicidal thoughts. But within three to six weeks, Menzies says, the brain regenerates and good sensations return.
Stephanie’s parents noticed a difference almost immediately. Her bitterness subsided. She came out of her room to have conversations. And she gave them pawnshop receipts so they could buy back everything she had stolen.
Stephanie, along with those in the addiction treatment industry, caution that Vivitrol must be coupled with therapy to work.
And the monthly injections cost about $800 to $1,200 each.
Another hurdle is that Vivitrol can be overridden with large amounts of opiates or alcohol. Stephanie said she once drank more than she could remember, trying to get drunk before the shot wore off.
“I remember getting mad because I kept drinking and couldn’t get drunk,” she said.
So far, Vivitrol and Naltrexone have only proven effective for opiate and alcohol dependence. But McCann, of the National Institute on Drug Abuse, says his agency is funding research on its effectiveness on methamphetamine addicts.
One of the drug’s biggest handicaps is requiring an addict be sober for at least seven days before taking it, McCann said.
“Requiring they not use for one week rules out a lot of subjects who can’t get clean for that period of time,” he said.
In a medical emergency, physicians cannot relieve pain for patients taking Vivitrol.
And the medication also carries a black-box warning due to liver problems that can arise if used in high doses — about five times the amount used to treat addicts, McCann said.
“But unlike a new drug that’s been approved for the first time, this has been used for 30 years,” he said. “It’s doubtful at this point that there are any side effects that would pop up.”
COUNTING THE DAYS
Vivitrol pamphlets line some shelves inside St. Louis Circuit Court Judge James Sullivan’s chambers. He oversees the city’s drug court and started referring offenders to Vivitrol centers about three years ago, after would-be participants were dying from overdoses before they got a chance to stand before him. Along with Menzies’, about three other clinics in the area offer the medication.
Now, between 60 and 70 people of the 260 on Sullivan’s docket are taking Vivitrol, he said.
Therapy is still mandatory for every participant in the 11- to 16-month program, which gives drug and alcohol offenders a chance to sober up instead of serving prison time. But few remain on Vivitrol upon completion, Sullivan said.
“Vivitrol has assisted us in reaching some very difficult long-term addicts and alcoholics who have not been able to benefit from listening to drug treatment programs that are focused on treatment rather than the cravings,” he said. “Vivitrol recharges their batteries.”
In 2010, researchers studied 64 participants from Sullivan’s court along with two Michigan drug courts. Half were given Vivitrol and therapy, and the other half got therapy alone.
Vivitrol patients were about 57 percent less likely to miss drug court sessions. About 26 percent of non-Vivitrol clients were rearrested, compared to 8 percent of those who took Vivitrol, according to the Alkermes-funded study published in the Journal of Substance Abuse Treatment in 2011.
Keeping addicts from re-entering the criminal justice system, the study estimated, saves between $4,000 to $12,000 per person after an initial arrest.
Those kind of savings have attracted the attention of Mark Stringer, director of behavioral health for the Missouri Department of Mental Health.
From December 2008 through February of this year, the state spent about $4.3 million connecting nearly 2,000 addicts to Vivitrol, via providers such as Menzies.
In May, the state began offering to pay for one Vivitrol shot for prisoners leaving the Ozark Correctional Center. But Stringer said there is more demand for the drug than the state can afford because many who need it are uninsured.
In Stephanie’s case, Medicaid covered 24 shots, the last of which she took in January. Without Medicaid, Stephanie said, she couldn’t have afforded the medication.
Even though she knows she can get high now, she doesn’t.
“I know it would only make things worse,” she said, as her dad quietly mouthed the word, “Yes.”
She still attends therapy with her parents at Menzies’ clinic.
She dreams of working with autistic children — an interest she said she developed while confined with some of them in psychiatric wards. For now, she’s working at a thrift store not far from her house.
And she’s attending parenting classes, with the hope of regaining custody of her son.
For the last month, Stephanie has been getting her son ready for day care without her mother’s watchful eye.
Trust is something Vivitrol can’t restore among mother and daughter. Little things, like seeing spoons in her silverware drawer, trigger memories of how Stephanie once used them to cook heroin.
“I still count the spoons,” Marcia Willis said. “And I probably always will.”
Stephanie counts, too — the number of days she’s been sober.
Dopamine is the body’s pleasure hormone, released when a person engages in survival behavior, such as eating or drinking. Endorphins are released during pain or stress relief or emotional bonding, which stimulates the brain’s opiate receptors, sending a surge of dopamine into the bloodstream.
Opiates and alcohol act as artificial endorphins that stimulate the brain’s opiate receptors, prompting a surge of dopamine into the bloodstream. Eventually, the body’s natural endorphin and dopamine production system shuts down, so an addict or alcoholic must abuse opiates or alcohol to feel normal.
Vivitrol blocks endorphins from bonding to opiate receptors. Within a few weeks, dopamine begins to be released naturally into the bloodstream in response to survival behavior. Eventually, the brain also grows new opiate receptor sites to receive endorphins responding to pain, stress and emotional bonding.
Source: National Institute on Drug Abuse