Santa Cruz has long faced problems with prevalent drug use. Not only has the city become a hub for black tar heroin, but alcohol is also an ever-present issue. Despite an allowed amount of 102 alcohol outlets, there are currently 249 alcohol-serving establishments in the city, according to the city’s Public Citizen Safety Task Force 2013 report.

In an effort to combat the issue, Santa Cruz is an active member in the Vivitrol pilot program. Vivitrol, an opioid receptor antagonist, blocks off cravings for alcohol and opiates such as heroin, opium or morphine.

Bill Manov, Ph.D. and Chief of the County Alcohol and Drug Program, helped bring the pilot program to Santa Cruz.

“I became aware of a number of other counties piloting Vivitrol and we have been interested in supporting medication-assisted treatment for substance abusers for a while,” Manov said. “This is a relatively new medication and research on it is pretty solid in regards to supporting treatment outcomes.”

The pilot program allows county drug officials to administer Vivitrol to a small group of individuals. Independent drug rehabilitation centers, such as Janus Community Clinic, also administer Vivitrol to a limited number of people. It’s administered to patients once a month as an injection in the shoulder.

Vivitrol, derived from naltrexone, was first given FDA approval in 2006. It was initially only approved for dealing with alcohol dependency, but in 2010, the FDA approved it for combating opiate dependency.

Potential Vivitrol users need to have opiates cleared from their system for seven to 14 days before being administered, according to the Vivitrol website. If not, one could suffer through an immediate opiate withdrawal stage and require hospital care.

Cecilia Krebs is the program director at Janus Community Clinic, an independent rehabilitation center.

“Vivitrol is given to people who sustained abstinence [from opiates] and people who are worried they will be triggered by situations or social interactions and are concerned whether or not their interaction will allow them to remain abstinent,” Krebs said.

The once-a-month injection places a greater amount of control in the hands of the user as opposed to a regimen of daily pills, Manov said. It is easier for an addict to go to a clinic once each month to receive a shot as opposed to ensuring he or she takes a number of pills on a daily basis.

“With Vivitrol, you get it once a month … so if you’re trying to stay clean, you get a once-a-month shot that basically blocks the opiate receptors in the brain so you can’t get high,” Manov said.

Although he sees the potential Vivitrol has, Deputy Chief of police Steve Clark said that to see a marked decline in drug use, Santa Cruzans will need to change the way they view drugs.

“There has always been a playful atmosphere prevailing where we don’t take drug offenses seriously and we don’t effectively deal with the behavior,” Clark said in a phone interview. “There is this real dissonance out there with people who don’t understand that it ravages lives.”
After moving past their addictions, users can reemerge into society with things other than opiates on their minds, Krebs said.

“As long as they’re taking their recommended dosage and not using other drugs, they can live a perfectly normal life,” Manov said. “Some people have different brain chemistries and abilities to cater to a drug-free lifestyle. For others, Vivitrol is the pathway to a drug-free stable recovery.”

The drug was recently added to MediCal, making it more accessible. For those without insurance, Vivitrol offers a $500-a-month assistance program to help pay the $1,100 cost per dosage.
Users are required to be in either therapy sessions or counseling in addition to their drug regimen to better fight their addictions.

“Folks are typically on Vivitrol for about six months,” Manov said. “The basic idea is you need this medication support for staying clean for a period of time until your recovery is stable enough that you no longer need this assistance.”

Clark said he hopes the drug problem will be addressed at the legislative level to save city resources. Wasted squad car fuel and diverted manpower take away from the limited police budget, Clark said. Stricter laws would place users behind bars faster and allow police to focus on other matters.

“As it stands now, it takes an individual five or six times before anything substantive happens to them,” Clark said. “So you look at the amount of police resources going into that and you wonder why didn’t we draw the line on that individual earlier?”

Though it is currently marketed for fighting both alcohol and opiate dependence, new research shows the drug’s effectiveness when dealing with both nicotine and methamphetamine addictions.
Despite the drug’s benefits, Manov cautions against blind trust in Vivitrol.

“It’s important to note that it reduces — but does not eliminate — cravings,” Manov said. “I fear people will be looking for the wonder drug eliminating addiction and we haven’t found that one yet. But still, this one is very useful.”