SUMMARY REPORT
MEETING 9
Date: Wednesday, January 25, 2012
Time: 10:30AM – 12:00PM
Hosts: UCLA Integrated Substance Abuse Programs (ISAP) & CA Dept. of Alcohol and Drug Programs (ADP)
Topic: Vivitrol: A Medication for Treating Alcohol and Opiate Dependence
Presenters: John Viernes, Desiree A. Crevecoeur-MacPhail, Ph.D., and
Kathy Jett
Review of ILC Meeting 8
UCLA ISAP
§ The eighth ILC meeting, conducted on December 14, 2011, showcased the Process Improvement Project at CCH in Los Angeles. Special thanks to Desiree A. Crevecoeur-MacPhail who described the program and responded to questions posed in an open forum from meeting attendees. Thank you all for your participation. A summary from this meeting has been posted on the UCLA ILC webpage: http://www.uclaisap.org/Affordable-Care-Act/html/learning-collaborative/index.html
Logistics
§ Summary and materials discussed from the previous ILC meetings are available at http://www.uclaisap.org/Affordable-Care-Act/html/learning-collaborative/index.html. Subsequent meeting materials will continue to be posted on this site.
§ The next ILC meeting will be held on February 22, 2012 from 11:00AM to 12:00PM. UCLA has invited Lily Alvarez and Darren Urada to present on the Project Care integration project in Kern County.
§ All further meetings are scheduled to be held at 11:00AM (PT) on the 4th Wednesday of every month, unless otherwise noted.
ILC Meeting 9 Topic:
Vivitrol: A Medication for Treating Alcohol and Opiate Dependence
Topic Introduction – Darren Urada, Ph.D., UCLA ISAP
§ The topic for today’s learning collaborative is to hear about the Vivitrol Project in Los Angeles County. Kathy Jett will also be providing a Criminal Justice Perspective. We thank John Viernes, Desiree Crevecoeur-MacPhail, and Kathy Jett for being willing to share her work and hope this will be a learning opportunity for those in the audience but also for the speaker. Questions and trouble shooting among the group are encouraged.
Summary
· Background
o In 2006, an injectable extended release Naltrexone was FDA approved for the treatment of alcoholism; in 2011, Vivitrol was FDA approved for the treatment of opiate addiction.
o Vivitrol is an opioid receptor antagonist that blocks the mu-opioid receptors in the brain.
o Vivitrol has shown to reduce the number of risky/heavy drinking days and improve the individual’s quality of life.
· Los Angeles County Vivitrol Pilot Project Evaluation
o The three medication hubs used for the study were the Tarzana Treatment Center, Behavioral Health Services, and Prototypes.
§ Selection criteria included having an infrastructure able to administer medications and a long-standing history of quality SUD treatment.
· Results and findings
o Counselor attitudes improved over the course of the project and many who initially reported neutral or negative attitudes towards medication-assisted treatment in general or Vivitrol in particular, reported positive attitudes on the follow-up survey.
o Urges to drink decreased from a baseline score of 19.3 to 6.6 at week 4 (i.e. urges reduced by 66%).
o Limited side effects
§ Only 16 clients (4%) stopped taking the medication due to the side effects.
§ The most common side effects reported for Vivitrol included fatigue, headache, injection site reaction and nausea.
§ The proportion of clients reporting these side effects differed over the first four weeks of treatment with few reporting side effects in the first week (13.9% fatigue, 15.2% headache, 10.0% injection site reaction, and 14.9% nausea).
§ In week 4, side effects were reported by less than 10% of the clients (7.0% fatigue, 7.7% headache, 5.7% injection site reaction, and 7.5% nausea)
· Conclusions
o In this pilot, Vivitrol;
§ Increased the number of clients who complete treatment in detoxification, outpatient counseling and residential treatment programs.
§ Decreased substance use in outpatient counseling and residential treatment.
§ Increased treatment engagement (outpatient and residential) and treatment continuance for residential treatment.
· Kathy Jett provided a criminal justice perspective on the use of Vivitrol and Medication Assisted Treatment (MAT).
§ Pennsylvania and New York are doing MAT studies in the criminal justice population; we can look to their work for guidance.
§ The criminal justice budget is second in spending to Medicaid; funding of MAT presents a real challenge.
§ MAT is also perceived as divertible, which is a real barrier in the criminal justice population, also we don’t rehabilitate in prison.
§ The substance use treatment and criminal justice industries need to come together to effect change. AB109 presents additional challenges to the system.
Closing Remarks – Darren Urada, UCLA ISAP
§ Thanks again to John Viernes, Desiree Crevecoeur-MacPhail and Kathy Jett for sharing today. It is always helpful to hear from the people actually working on integrated care. Thank you for volunteering your time and sharing with the group.
§ The next ILC Meeting is scheduled on Wednesday February 22, 2012 (teleconference).
§ Please remember to reference the website which holds all information and materials disseminated from the ILC: http://www.uclaisap.org/Affordable-Care-Act/html/learning-collaborative/index.html.
APPENDIX 1 – ATTENDEES
COUNTY PARTICIPANTS
MBA
Ø Amador (Pat Bartosiewicz, Jennifer Magee, Sherry Parkey)
Ø Del Norte (Jill Fullington)
Ø Calaveras (David Sackman)
Ø Colusa (Deana Fleming)
Ø Glenn (Erin Valdez, Thomas Waggoner)
Ø Inyo (Linda Benson)
Ø Lake (Linda Morris)
Ø Lassen (Linda Morris, David Rothery, Anita Harsh, Sue Bandouski)
Ø Mariposa (Linda Murdock)
Ø Mono (Robin Roberts)
Ø Modoc (Tara Shepherd)
Ø San Benito (Alan Yamamoto)
Ø Sierra (Rhonda Grandi)
Ø Siskiyou (Randy Davis)
Ø Tehama (Susan McVean)
SMALL
Ø Butte (Dean True, Marion Reeves)
Ø El Dorado (Shirley White)
Ø Humboldt (Helene Barney)
Ø Kings (Brenda Randle)
Ø Madera (Sonja Bentley, Cesar Velasquez)
Ø Mendocino (Leslie Kirkpatrick)
Ø Merced (Manuel Jimenez, Natalie Vasquez, Kathleen Reyes, Tabatha Weeda)
Ø Napa (Karen McElroy, Lisa Montanez, Connie Moreno-Peraza)
Ø Nevada (Mary Lowe)
Ø Shasta (David Reiter)
Ø Sutter & Yuba (Nancy Lee)
Ø Yolo (Mark Brian)
MEDIUM
Ø Kern (Lily Alvarez)
Ø Marin (Michael Hodges, DJ Pierce)
Ø Monterey (Robert Jackson)
Ø Placer (Amy Ellis, Cheryl Renwita)
Ø San Joaquin (Vic Singh, Curt Willems)
Ø Santa Barbara (J. Doyle)
Ø Santa Cruz (Bill Manov)
Ø Solano (Andrew Williamson)
Ø Sonoma (Derrick West)
Ø Stanislaus (Madelyn Schlaepfer)
Ø Tulare (Michelle Reynoso)
LARGE
Ø Alameda (Tom Trabin)
Ø Contra Costa (Karen Fearn)
Ø Fresno (Dennis Koch)
Ø Los Angeles (John Viernes)
Ø Orange County (Brett O’Brien)
Ø Riverside (Karen Kane)
Ø Sacramento (Lisa Scott-Lee, Maria Morfin, Melinda Avey, Paul Tanner)
Ø San Bernardino (Dianne Sceranka, Vicki Baumbach, Gary Atkins)
Ø San Diego (Marshall Lewis, Angie DeVoss, Susan Bower)
Ø San Francisco (Alice Gleghorn)
Ø San Mateo (Clara Boyden, Keith Clausen)
Ø Santa Clara (Michael Hutchinson, Nubia Torres, Robert Gardner)
Ø Ventura (Patrick Zarate)
ORGANIZATION PARTICIPANTS
Ø ADPI (Victor Kogler)
Ø CAADPE (Albert Senella)
Ø CADPAAC (Tom Renfree)
ADP Participants
Ø Michael Borunda
Ø Cynthia Castillo
Ø Craig Chaffee
Ø Tina Chiginsky
Ø Debra Connick
Ø Michael Cunningham
Ø Jessica Delgado
Ø Darien De Lu
Ø Mary Dodson
Ø Jonathan Graham
Ø Theresa Gulley-Reed
Ø Cynthia Guest
Ø Gayle Hirahara
Ø Sally Jew-Lochman
Ø Janine LaMar
Ø Marjorie McKisson
Ø Maurilio Mendez
Ø Dave Neilsen
Ø Katrina Parker
Ø Nanette Rufo
Ø Suzi Rupp
Ø Gigi Smith
Ø Denise Wallace Warrick
Ø Kevin Wortell
Ø Marcia Yamamoto
Ø Angela Zamora
Ø Trinidad Perez
UCLA Participants
Ø Darren Urada
Ø Sherry Larkins
Ø Desiree Crevecoeur-MacPhail
APPENDIX 2 – Agenda and Relevant Materials
· Overview of Meeting 8
· Introductions
· Topic discussion – Vivitrol: A Medication for Treating Alcohol and Opiate Dependence
1. John Viernes & Desiree Crevecoeur-MacPhail – Results of the Vivitrol Project in Los Angeles County
2. Kathy Jett – A Criminal Justice Prospective
· Q and A
Materials for this meeting
· PPT Presentation – John Viernes and Desiree A. Crevecoeur-MacPhail, Ph.D.
Copies of materials can be found at UCLA ISAP’s ACA Resources Website:
http://www.uclaisap.org/Affordable-Care-Act/html/learning-collaborative/index.html.