"I needed that accountability and extra help to navigate," says drug court graduate
Even if SeVon Hill takes heroin, he can’t feel it — which is the way he wants it.
In June, the 22-year-old Tacoma man started getting monthly injections of naltrexone, which curbs cravings for opioids and alcohol, as part of his court-ordered treatment plan.
“It’s kind of like it rewired my brain,” Hill said. “I don’t understand how it did it, but it did.”
The monthly naltrexone, commonly known as Vivitrol, became an option last year for people going through Pierce County’s court system for drug-related crimes.
Pierce County Drug Court, like others across the country, has become increasingly supportive of medication-assisted treatment in recent years.
The specialty court gives people charged with drug-related crimes the chance to do an intense treatment program with court oversight, in exchange for charges being dismissed if they graduate the program.
When Drug Court started in 1994, the focus on being drug-free meant medication wasn’t part of the treatment. Like many drug courts across the country, that’s since evolved, and naltrexone, which isn’t a mood-altering substance, has become the medication of choice.
Hill is one of about 50 participants who Drug Court has referred for medication-assisted treatment since early last year. Most are naltrexone patients, though a few are on other medicines.
Punctuating the national trend, federal grant language changed in early 2015 to say funding would be contingent on courts offering medication-assisted treatment.
The court’s monthly naltrexone program and the federal language change happened about the same time, but officials said they weren’t related.
Even before offering monthly naltrexone, the court had participants who used other medicines to treat addiction, said Jami Bonomo, who oversees the court’s medication-assisted treatment program. And she said court officials had been talking about using naltrexone injections before the federal language changed.
Bonomo works for the Pierce County Alliance, a nonprofit that focuses on substance abuse treatment and mental health, and partners with Drug Court.
“I’ve had a lot of feedback from clients that it’s like a miracle,” Bonomo said about monthly naltrexone.
Since its implementation, the medication has been helping people in Drug Court focus on treatment, which means fewer must be held in jail as they wait for a treatment bed to open up, she said.
And if they slip and are ordered to do a brief jail stint, the monthly injections can be scheduled more easily around time behind bars than medicines that require daily doses.
Superior Court Judge Elizabeth Martin, who presides over Drug Court, doesn’t see naltrexone as an easy solution to addiction. But she has seen it help many people in her courtroom.
“Having one more tool is really important,” Martin said. “It isn’t a magic bullet; it just helps.”
Many people who go through Drug Court don’t use addiction medication. Counseling, group therapy, in-patient and out-patient treatment and daily check-ins can be other parts of the program.
Crystalin Mendoza, 27, graduated from the family recovery branch of Drug Court in June after doing an in-patient treatment program. The family drug court is aimed at reuniting graduates with their children, and Mendoza now has custody of her 3-year-old daughter.
Medication wasn’t part of her Drug Court experience. She tried buprenorphine when she lived in Illinois, but it didn’t keep her from doing heroin if it was around, Mendoza said.
The therapy, which requires participants to examine the root causes of their drug use, made a difference for her, she said. The support of others in Drug Court was important as well.
“I needed that accountability,” Mendoza said.
After graduating from Drug Court, she became a full-time student at Tacoma Community College, and her toddler is in preschool five days a week.
In Hill’s case, naltrexone was a must, he said.
“I wouldn’t have been able to quit, period,” he said.
But to get on naltrexone, patients must be drug free for seven to 10 days, which Hill struggled to do. The drug can cause severe withdrawal if a patient doesn’t detox first.
Drug Court ultimately ordered Hill to jail for seven days. He detoxed there, and started using naltrexone when he was released.
“Ever since I got the shot, I don’t think about (heroin) at all,” Hill said.
His doctor, board-certified addiction medication specialist Asif Rashid Khan, has been working with Drug Court for several years. He’s the CEO of Northwest Integrated Health, which is based in Tacoma.
When talking about medication for addiction, Khan uses the analogy of insulin prescribed for diabetics. Neither is a cure.
“To bring a real change in a chronic disease, you do need lifestyle changes,” he said.
Generally, patients take naltrexone for six to eight months.
A few Drug Court participants use buprenorphine (brand name Suboxone), which Khan can give immediately, without the seven-day detox. And one person is moving from methadone to naltrexone.
Methadone gives users a euphoric feeling and helps with pain, Khan said. Buprenorphine partially does that, and naltrexone does not.
On a recent visit to get his second shot, Hill told Khan he’d used heroin once, and had used methamphetamine since starting naltrexone in June.
Naltrexone doesn’t stop meth cravings, and Hill told Khan his Drug Court treatment plan for that addiction was to look for a job to take away his free time.
As for heroin, Hill said, the one time he used it, he felt nothing. The medicine doesn’t let him.
“I’ve been able to have more energy and not be so depressed,” he told Khan.
It makes it a little easier, Hill said after his appointment, that he can focus on his meth cravings, instead of also having to worry about craving heroin.
He’s working to get his driver’s license back, and he’s been working off court costs. His next step is to find a job and stable housing. Right now he lives with his grandmother.
Recently, he made it to the second of Drug Court’s four therapy phases.
It’s the naltrexone, Hill said, that helps him focus.
“It’s the only way to do it,” he said.