One of the states hit hardest by the opioid crisis shows us what's wrong with how we're fighting it

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  AP Photo/Al Behrman

  Judge Robert Peeler tries a case involving heroin abuse in Warren County Common Pleas Court, Tuesday, April 15, 2014, in Lebanon, Ohio. Peeler is among a growing number of judges and corrections officials across the country trying to combat the fast-growing national heroin problem by fighting heroin needles with treatment needles. Peeler sometimes orders monthly injections of the opiate-blocking drug Vivitrol to heroin users if they are willing.

  A new study looked at the effectiveness of drug treatments in court programs in Ohio.
• The study found 89% of participants were given Vivitrol, a treatment favored by judges but not most addiction doctors.
• Misconceptions about drug treatments are still very prevalent, making it harder for the public to get the "gold standard" treatment for opioid use disorder.

A study of addiction treatment programs in Ohio shows many of the problems with the current approach to the US opioid crisis. 

The study, conducted by nonprofit Treatment Research Institute, looked at 25 drug courts in Ohio in 2016 to determine the effectiveness of giving medication-assisted treatment to its participants - 500 in total. Ohio currently has the fourth-highest overdose death rate in the US.

Medication-assisted treatment uses prescription medications in conjunction with psychological therapy to help patients work on the underlying issues leading to their substance use, without the constant pressure of withdrawal.

There are a few primary medications that are used in the treatment. The most widely studied are maintenance drugs like buprenorphine and methadone, which are chemically similar to opioids and work by attaching to the same brain receptors, preventing users from using other opioids to get high while reducing cravings and withdrawal symptoms.

The other major medication is naltrexone, which stops the effects of opioids by completely blocking the brain receptors but does little to reduce cravings or withdrawal symptoms. Naltrexone is most often prescribed as Vivitrol, a monthly injection approved by the FDA in 2010 that has been criticized for its side effects and questionable success.

Numerous leading treatment officials and addiction doctors have touted buprenorphine and other maintenance treatments as the "gold standard." But it remains expensive, difficult to access, and often stigmatized by public officials as "substituting one opioid for another," as Health and Human Services Secretary Tom Price did in May. (He later walked back that statement.) 

Alkermes, the makers of Vivitrol, have capitalized on that stigma by marketing Vivitrol directly to drug courts, prisons, and other parts of the criminal-justice system. In many cases, the company targeted judges in areas hard hit by the opioid crisis - like Ohio - with a bias toward viewing addiction as a moral weakness.

It appears to have worked. 

One of the main objectives of the study was to compare the effectiveness of buprenorphine and Vivitrol. It wasn't able to do that, however, because it found that 89% of the drug court participants studied were given Vivitrol. In many cases, Vivitrol was the only treatment offered to participants. That left the study with too small of a sample size to adequately compare the two medications.

The implication is clear: Drug court judges in Ohio heavily prefer and are often mandating the use of Vivitrol, a phenomenon that many doctors have found problematic.

When judges mandate a particular treatment without consulting medical personnel, they are "practicing medicine from the bench," Dr. Devang Gandhi, the head of the University of Maryland's addiction residency program, told Business Insider. 

The issue, Gandhi said, is that "decisions are made by judges who don't really understand what these medications are," often leaving participants with "inappropriate" treatments. 

Further, the study, which was initiated after the state legislature invested an $11 million last year to expand medication-assisted treatment in the criminal justice system, found that the stigma around the treatments remains prevalent. 

Over 70% of the drug courts or agencies studied reported "widespread misconceptions and misinformation" of medication-assisted treatment, furthering negative opinions.

Nearly half of community members, including participants, reported seeing medication-assisted treatment as a "crutch." The misconceptions went the other way as well - one-quarter of community members reported seeing the treatment as a "magic bullet," meaning that they thought if participants got the medication, they didn't need support or psychological treatment to recover. 

AP Photo/Carla K. Johnson, File

Vivitrol

"Because of bias and misinformation and outright lying, addicts are told [buprenorphine is] not a good treatment ... that it's just another addiction," said Mark Willenbring, a leading addiction psychiatrist who runs Alltyr, a treatment clinic in Minneapolis.

"Unless you consider diabetic people addicted to insulin, there really is no difference," he told Business Insider.

One Ohio advocate, Sandi Kuehn, the CEO of the Center for Addiction Treatment in Cincinnati, said that local coverage of the study in the Cleveland Plain-Dealer, the largest newspaper in Ohio, did little to clear up the misconceptions. The article's headline ("Study: Relapse prevention medications like Vivitrol and Suboxone used in drug courts have minimal impact on recidivism"), she noted, didn't accurately reflect the study, which found that "the use of MAT in drug courts appears to be an effective strategy for improving client retention."

Further, the story lumped together the success rates of Vivitrol and Suboxone (the brand name for buprenorphine) despite the fact that they are two different types of treatments - and that the vast majority of those studied used Vivitrol. 

Kuehn, whose organization rarely prescribes Vivitrol, told Business Insider that "misconceptions" around Suboxone and other medication-assisted treatment have been rife in the justice system and elsewhere since the treatments were first introduced - attitudes that "haven't changed a whole lot" in more than a decade since.

Kuehn said that, while the Plain-Dealer's coverage was "concerning," the study itself, which acknowledges that MAT works, is a "baby step" in the right direction.