Anti-opiate drug ads on Mass. transit raise questions for doctors

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BOSTON — Vivitrol is described by some doctors as a “silver bullet” to help heroin and opioid addicts kick the habit, and the drug’s manufacturer is seeking to capitalize on its rising popularity.

Alkermes, the Ireland-based company that makes Vivitrol, is spending hundreds of thousands of dollars to advertise the drug on the Massachusetts Bay Transportation Authority’s (MBTA) commuter rail, bus and subway systems.

Ads will also appear in South Station and at Downtown Crossing, according to the state-run MBTA.

Posters and digital ads read “What is Vivitrol?” and direct people to the company’s website, which has information about the drug and where to get it, as well as stories from recovering addicts.

“When Vivitrol was added to my recovery program, it really helped reduce my cravings and help keep me from relapsing,” explains “Carrie,” a 31-year-old mother, in a 10-minute video that includes disclaimers about the drug’s possible side effects.

But the ads pose a dilemma for the state’s medical community, which generally opposes direct advertising by pharmaceutical companies but sees huge potential in the drug to combat a deadly spike in opioid addiction.

“It would be better served if we had advertising more aimed at raising awareness of the issues of substance use disorder and available treatments,” said Dr. Dennis M. Dimitri, president of the Massachusetts Medical Society. “We would be more comfortable if the advertisement focused on treatment, as opposed to pushing demand for one particular medication.”

Still, Dimitri admitted that an unprecedented “public health crisis” created by opioid addiction — which claims an average of four lives a day to accidental overdoses in Massachusetts — has addicts and families desperate for solutions.

“Perhaps one can understand why the manufacturer of a drug like Vivitrol would be more likely to advertise it,” he said.

A spokeswoman for Alkermes, which has a facility in Waltham, said the company’s public transit ad campaign is aimed at raising awareness of treatment options for opioid addiction. The ads are running in other states.

“It is important for people battling this disease to be aware of all treatments available for opioid dependence, and talk with their doctor to determine what the right option is for them,” said Jennifer Snyder, the company’s director of corporate communications, in a written statement.

The U.S. Food and Drug Administration approved Vivitrol in 2006 for treating alcohol addiction. Four years later, it authorized use of the drug to treat addiction to heroin or prescription narcotics.

Unlike other drugs used to treat opioid addiction, Vivitrol is a non-narcotic form of naltrexone. It is injected monthly and works by blocking the opioid receptors in the brain.

Currently, about 15,000 addicts nationwide are receiving Vivitrol treatments, according to the company.

“It blocks the cravings and takes away the high,” said Dr. Suzanne Rothchild, patient care coordinator at North Shore Neurological Associates, one of several facilities on the North Shore that treats patients with Vivitrol. “But they have to be at least 10 days clean before they take it, or they’ll go into immediate withdrawal.”

A recent FDA study found patients treated with Vivitrol were more likely to stay in treatment and less likely to relapse. At least 36 percent of those who took Vivitrol finished a six-month program, compared to 23 percent of those who didn’t.

But the drug’s hefty price — about $1,300 per shot — puts it out of reach of some addicts.

Snyder said Alkermes offers a payment plan that covers up to $500 a month of a qualifying patient’s expenses, in addition to what most private insurers pay.

The U.S. Department of Health and Human Services says Vivitrol has “no potential for abuse,” unlike the alternative drugs Suboxone and methadone, which are sometimes used illegally by addicts, smuggled into prisons or sold on the street.

Still, Dr. Jeffrey Eisen, medical director of community services at Lahey Health Behavioral Services, which offers Vivitrol treatments, said there are risks, particularly if addicts attempt to “overcome” Vivitrol’s effects with large quantities of opioids.

“You could get high, but you could also overdose,” he said.

Federal and state laws limit the number of patients that individual physicians can treat with Suboxone and methadone, which has dramatically increased demand for Vivitrol, according to substance abuse treatment experts.

“A lot of the people choose Vivitrol because they can’t find Suboxone providers,” Rothchild said.

That demand drove up Vivitrol sales 29 percent year over year, to $38.2 million in the fourth quarter of 2015, according to the company’s earnings report. Alkermes projects net sales of Vivitrol to reach $200 million in 2016.

The state Department of Public Health, which also sees promise in expanding the use of Vivitrol to curb opioid abuse, is tracking patients at state-run treatment facilities to study its effectiveness on long-term recovery.

Last year, state lawmakers approved a two-year, $2.5 million pilot program as part of the fiscal 2016 budget that makes it easier for patients to access Vivitrol.

State Rep. Linda Campbell, D-Methuen, whose Merrimack Valley district has been hit hard by the opioid problem, said she doesn’t have any quarrel with Vivitrol ads, but she wants the company to do more to educate the public.

“What I would like to see is that their ads also emphasize the benefits of a comprehensive approach to treatment that includes behavioral counseling,” she said. “Additionally, more financial contributions by the industry to fund more treatment as well as their commitment not to price gouge.”

Christian M. Wade covers the Massachusetts Statehouse for CNHI’s newspapers and websites. Reach him at cwade@cnhi.com.

 

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