Philip Kirby says he felt pressured into taking Vivitrol for his heroin addiction by his drug court treatment program. “Like I couldn’t come into the program until I got it,” he says.
Jake Harper/Side Effects Public Media
Philip Kirby says he first used heroin during a stint in a halfway house a few years ago, when he was 21 years old. He quickly formed a habit.
“You can’t really dabble in it,” he says.
Late last year, Kirby was driving with drugs and a syringe in his car when he got pulled over. He went to jail for a few months on a separate charge before entering a drug court program in Hamilton County, Ind., north of Indianapolis. But before Kirby started, he says the court pressured him to get a shot of a drug called Vivitrol.
Vivitrol is a monthly injection of naltrexone, which blocks opioid receptors in the brain. It’s one of three medications approved by the Food and Drug Administration for treating opioid addiction. While it’s effective in some people, it’s not for everyone. Patients have to be ready to be opioid-free, and some patients won’t do well on it. It can also have side effects, which Kirby says he experienced.
“I had sinus problems, chest problems for the whole month I was on it,” Kirby says. “I couldn’t shake it.”
He says he also got a rash — another possible reaction to Vivitrol, according to the product’s warnings. Months after he had the shot, he still had white splotches on his arms, which he attributed to the drug. But even with those symptoms, Kirby says the court urged him to stick with the medication for a couple more months. “They were way too pushy about it,” he says.
More than 130,000 Americans will go through drug courts this year, according to the National Association of Drug Court Professionals. Drug courts are designed to allow some people whose crimes stem from addiction to get treatment instead of jail time. But the treatment that is offered varies from court to court and is entirely at the judge’s discretion.
Some courts offer participants a full range of evidence-based treatment, including medication-assisted treatment. Others don’t allow addiction medications at all. And some permit just one: Vivitrol.
Prime targets for marketing
One reason for this preference is that Alkermes, the drug’s manufacturer, is doing something nearly unheard of for a pharmaceutical company: It is marketing directly to drug court judges and other officials.
The strategy capitalizes on a market primed to prefer their product. Judges, prosecutors and other criminal justice officials can be suspicious of the other FDA-approved addiction medications, buprenorphine and methadone, because they are themselves opioids. Alkermes promotes its product as “nonaddictive.”
The argument worked for Judge Lewis Gregory, who heads the city court in Greenwood, Ind. About a year and a half ago, Gregory didn’t allow participants to start on addiction medications while in the program. “We were failing miserably with the heroin population,” he says.
Judge Lewis Gregory, head of the city court in Greenwood, Ind., began allowing drug court participants to begin taking Vivitrol after meeting with an Alkermes sales representative.
Jake Harper/Side Effects Public Media
At the time, Gregory was only familiar with buprenorphine and methadone. Both are opioid medications that can prevent withdrawals, reduce cravings and ultimately help people maintain a stable recovery. When they are properly prescribed and administered, patients don’t get a euphoric feeling or a “high.”
Buprenorphine and methadone have been the standard of care for opioid addiction for years, but because they’re opioids, it is possible to misuse them. They’re also sold illegally on the street.
“I was certainly not going to do a medication-assisted treatment program with drugs which people use to get high,” Gregory says, adding that he would not order someone to stop buprenorphine treatment if it were legally prescribed by a physician, a situation he rarely sees.
Then he received some Vivitrol literature in the mail and a phone call from an Alkermes sales representative. “So we ended up meeting in the early part of 2016, and she began educating me a bit,” he says.
Six months later, his court began a Vivitrol program, permitting some participants to use the drug. A sales representative sometimes sits in on the court’s treatment team meetings, Gregory says.
Many treatment specialists say allowing judges and other criminal justice officials with no medical training to exert influence over medical decisions is problematic. The power makes them prime targets for Vivitrol marketing, they say.
“You would think it would be more appropriate to go after physicians,” says Basia Andraka-Christou, who researches drug courts at the Fairbanks School of Public Health at Indiana University.
“What this is implying is that the judges in these cases are actually making a lot of the medical decisions, and that should be very concerning to everyone,” she says.
Adriane Fugh-Berman, who researches pharmaceutical marketing at Georgetown University, says she has not heard of another drug company going after judges. She says it’s not just unique — it’s inappropriate and could ultimately be damaging to patients. “They’re not health care providers. They don’t know data. They don’t know research,” she says.
A company strategy
The drug court Kirby went through doesn’t allow medications other than Vivitrol for treating addiction. In fact, NPR and Side Effects Public Media have identified at least eight courts out of the several dozen in Indiana that say they only allow Vivitrol treatment.
NPR and Side Effects Public Media have learned that Alkermes sales reps have also marketed the drug to court officials in Missouri and Ohio. A report from ProPublica found that extensive marketing is leading judges to favor Vivitrol around the country.
The company is open about this part of its sales strategy. At an investor event last year, policy director Jeff Harris said that drug courts are a huge market for Vivitrol.
“We’re making progress but still just barely scratching the surface on the need that exists across the country,” Harris said in a presentation. “There are over 3,000 counties in the United States, and there are over 3,000 drug courts.”