A 14-month-old boy in Duchesne County recently overdosed on fentanyl, an ultra-powerful synthetic opioid. Five adults living with him gave him access to the drug. Their household had indications of being a drug cartel storefront. A few days later, police in Salt Lake City arrested a suspect holding 1,000 fentanyl pills for sale, enough to cause several hundred fatal overdoses. Officers frequently arrest others who intend to sell heroin, oxycontin and other opioids to addicts and potential addicts.
Most of us probably know sad families and friends of addicts and innocent victims exposed to opioid dependency and overdoses. The danger is made far worse by cheap, available, deadly fentanyl. Naloxone shots can stop some overdoses — this time — but may be administered too late. Their availability can also create a moral hazard of invincibility feelings among abusers, leading to a “next time.” They are not a reliable solution as overdoses continue and accelerate.
Families see savings wiped out and the state and counties spend millions on serial opioid treatments that are not very relapse-proof. Many treatment protocols leave the addict still subject to overdosing as they rely on ineffective detoxification and counseling, or programs substituting less-deadly but still addictive synthetic opioids such as methadone for more dangerous substances while leaving constant cravings in place.
Our law enforcement and social agencies do all they are allowed to stop illegal opioids from distribution in our state. But with drugs coming over our borders in industrial proportions with approval of corrupt Mexican officials, police are reduced to plugging the flood with a finger in the dike. So what do we do to stop demand and block the market?
With $130 million coming into the state from the opioid settlement fund, we have an option for treatment that stops abuse rather than feeding it with another addictive drug and a craving for the next fix. The option uses a naltrexone (not naloxone) implant following a detoxification period. It’s about twice as expensive as a methadone course, but in the long run families, the state and counties can avoid pouring thousands into often ineffective, repeated treatments lasting decades.
Here’s how it works: Supervised detoxification is necessary to rid the body of drugs. It must be supervised to prevent secret drug abuse and because detox can be fatal if done improperly. Next are two options to block opioid craving: 1) a monthly injection of Vivitrol (naltrexone in injectable form); or 2) a more effective option of implanting a naltrexone pellet from a compounding pharmacist in the hip or buttocks. A new pellet is implanted about every four months.
Research indicates addicts receiving Vivitrol injections are only one-seventeenth as likely to relapse, but with the implant it is almost impossible to relapse. There are anecdotes of people trying to dig out the implant, but at this point they are primarily just that — anecdotes. After about 18 months to two years of recovery, patients can switch to a cheaper, oral form of naltrexone they take the rest of their lives. Still, over time, it should be cheaper and definitely more effective than decades of methadone or counseling. It also works on alcohol, but not drugs like meth and cocaine. Many clinics in Utah further recommend short-term counseling such as moral reconation therapy to reorient destructive thinking processes and build self-reliance.
I am not a treatment expert. I do, however, have experience in the subject, having operated a felony drug court, a co-occurring disorder treatment court and one of the first two certified veterans treatment courts in Utah, with help from excellent treatment experts, law enforcement and probation officials, and court staff. Our success rates were and continue to be excellent, but the programs aren’t for everyone and resources are relatively scarce.
I was also a Marine commanding officer and judge advocate in the ’70s and ’80s while the military branches were still getting a handle on preventing heroin abuse with no good options, frequently leading to discharging addicted Marines and sailors. So I know more study, verification and planning will be necessary before spending public resources on naltrexone. Families and friends who can fund the treatment, however, might want to look into it by contacting a provider in Utah or in Arizona, where the treatment has been used for a longer time.
With private and public resources, we may be within reach of ending the days of burglaries and thefts to support habits, unemployment, and most of all, reducing death and heartache. Families and friends can have hope for their loved ones to return to a normal existence without daily risk of ruined, wasted lives.