Dr. Rahim Shafa holds a Naltrexone pellet before implant surgery.
(Ken McGagh photo)
Major hope for addicts: Leonard Morse Hospital is on cutting edge with pellet implants
By Cathy Flynn / News Staff WriterSunday, August 22, 2004
HOLLISTON -- Withdrawing from heroin was never easy for Charlie, an addict for two years.
"Whenever I tried to stop, I would feel like s--- for about two weeks," he said. "I'd go through the most insane depression and anxiety. I wanted to rip my insides out.
"Withdrawal is a thousand times worse than the flu. If I had a gun, I would have killed myself."
But today, Charlie, with a band wrapped around his upper arm, is a gaunt but determined soldier fighting an enemy that has ravaged his body, his relationships and his finances for years.
Under the armband and deep inside Charlie's arm is a 3/4-inch pellet of a drug called Naltrexone, embedded by a doctor at Leonard Morse Hospital in Natick. For the next two months, any heroin introduced into his system will make him feel very sick instead of high.
"I feel like a million bucks," said Charlie this week, less than a day after the surgery, while recovering at a friend's home with his mother Ann nearby. (Both Charlie and Ann asked that their real names not be used.)
The Naltrexone pellet works by blocking the effects of heroin and other opiates, and reducing the physical craving for the drug for two months. This gives addicts the strength they need to address their psychological cravings, another important step in recovery.
But there's a problem: The pellets are hard to get because they have not been approved by the Food and Drug Administration. Nor are they covered by insurance.
While addicts can use an FDA-approved, short-acting Naltrexone pill and Suboxone, another short-term pill, to withdraw, both pills have drawbacks.
Addicts and doctors point out that pills depend too much on the addict's willingness to take regular doses. A lapse can trigger withdrawal symptoms, and consequently, the craving for the illicit drug overcomes them. In addition, Suboxone, which is a narcotic, is hard to get because the U.S. Drug Enforcement Agency limits the doctors who can administer it.
Dr. Rahim Shafa, the Leonard Morse doctor who implanted Naltrexone in Charlie's arm, said that 40 of his patients have benefited from the pellets, which deliver a non-narcotic, slow-release dose that doesn't depend on the addict's remembering to take a pill.
"It's like a woman who doesn't want to get pregnant," said Shafa. "She can take a pill every day, or she can go on Norplant" (a contraceptive implant, which is less dependent on human error).
Shafa said the therapy has helped all but one of his patients kick their heroin addictions. The one who failed tried to test the drug's efficacy by consuming 50 bags of heroin in one day...far more than most addicts consume.
While the therapy seems promising, it too has its drawbacks. It is not recommended for people with damaged livers. Addicts must be ready to make a non-reversible decision about treatment. And the addict must go through a more conventional withdrawal and be clean for 10 days before the doctor implants the pellet. Charlie's doctors sedated him for a week to buffer the physical cravings.
But right now the biggest problem is lack of availability. Since the Naltrexone pellet has yet to be approved by the FDA, only five clinics in the U.S., including one at Leonard Morse Hospital in Natick, can dispense it under a special licensing arrangement with Pellet Technologies, the company run by pellet inventor Dr. Lance Gooberman. Without FDA approval, insurance won't cover the cost.
Shafa said that while he tries to keep the costs of the implants as low as possible (around $1,000), it still drives away many cash-depleted addicts. He estimates that full FDA approval for the pellets will require at least three years and several million dollars in testing.
"Insurance covers a stay in the detox center, but the companies are even shying away from that," said Shafa. "They're only taking the sickest of the crowd."
"The $1,000 would be a lot cheaper for the insurance company than sending an addict to detox for five days, which is not long enough," said Charlie.
For the region's growing number of heroin addicts -- lured by its cheap price, much cheaper than OxyContin and other narcotics -- the chance for a relatively inexpensive and painless withdrawal like the pellet can't come fast enough. Experts who deal with addicts say the spaces in conventional detox facilities have become more rare as the number of addicts soars.
"I tried to get a kid in a (detox) program recently, and it's a 30-day period to even get a callback from these places," said Bill Phillips, who runs New Beginnings, a Framingham-based recovery program for drug and alcohol abusers. "They are backed up because of the influx of drugs.
"Also, insurance companies only pay for the first two to three days in a detox center, and how can that possibly help? You have to be totally detoxed to figure things out, before you can even consider going to Alcoholics Anonymous and Narcotics Anonymous."
Phillips said he has seen many addicts relapse after a regimen of Suboxone pills because they can't summon the willpower to avoid the settings and people that got them hooked in the first place.
"You can't be around the old friends and the old places anymore," he said. "The pills are only a temporary thing, like a cop slowing you down for traffic. You need an 'after' plan."
Phillips said the fastest-growing group of addicts is young people living in MetroWest's affluent suburbs.
"This is an epidemic," he said. "I know of five people who died from it...all from the Framingham, Milford and Ashland area." Most of them get started for recreational reasons, he added.
"The kids I deal with are affluent -- they are upper class; they have access to money and the freedom to go to parties in Worcester and Boston, where they get the drugs."
Others get hooked on heroin after they get addicted to painkillers following a medical problem. One of Shafa's patients, a heroin addict, moved to the drug after he became hooked on Percocet following wisdom tooth surgery.
Chris, a Hopkinton man who has been through Phillips' program, said many addicts become that way because they have addictive personalities.
"An addiction is hereditary," he said. "If you have that addictive trait, you can become more dependent on a substance."
Chris is now recovering thanks to Suboxone.
Charlie was taking Percocet and OxyContin after back surgery, became addicted and began buying those drugs illegally after his doctor refused to refill his prescriptions. When the drugs got too expensive and hard to find, he moved to heroin, and eventually was paying $300 a day to shoot up 10 bundles, or 40 bags, of the drug.
His painting business began to falter, and he kept asking Ann for money "to pay his painters." The money actually went to his dealers.
Then, one day, Charlie's fiancee found him shooting up at their Hopkinton home. She rushed him into detox, and stayed by his side. Eventually, his relapses drove her away.
"I lost a $300,000 home, my girlfriend of 12 years, my car, my yellow Lab dog...everything," Charlie said.
And he said he knows several people who lost their lives, including some from Hopkinton and Ashland.
The addiction also tested Charlie's relationship with his mother. Ann had to sell her Hopkinton home because her finances were depleted by Charlie's bills. This week she moved to a smaller Northborough home, which has an in-law suite for her son.
"I had to take away his car to keep him away from his dealer," she said. "The stress of thinking that my son would die was too much. I knew there would come a day when I would see him in a casket."
Will the Naltrexone pellets become an easy way for Charlie and others to break free? Like her son, Ann is putting all her hopes in the implant.
"This surgery happened for a reason," she said.
Charlie, who said he hopes to become a counselor for addicts some day, said he has been in touch with U.S. Rep. Jim McGovern, D-3rd, and U.S. Sen. Edward Kennedy, D-Mass., to push for putting the pellets on the fast track with the FDA.
"People need to be helped," he said, "because they can't control this."