One Man’s War for the Medical Treatment of Addiction

This year marks the 30th anniversary of naltrexone, the most effective drug therapy on the market for alcoholism and heroin addiction. Despite years of clinical evidence that it works, the recovery community has dismissed the medical solution, but Percy Menzies is one health practitioner who is fighting back.

recovery-medsPercy Menzies sits in his office at the beginning of each day looking at the roster of new patients. Every day is a new battle, and every day has its winners and losers. Each time he enters a room of either new potential patients or community health practitioners to discuss how he can treat alcoholism, he is ready for a fight. He has to be. Years of resistance, particularly from those inundated with meetings of Alcoholics Anonymous, Narcotics Anonymous, and failed expensive residential treatments have made him hardened and battle ready to respond to commentary from people lost and confused when hearing his suggestion. “When I tell someone that first we have to break the never-ending cycle of cravings and withdrawal in order to make the counseling more effective, patients react with disbelief that a monthly shot of a non-addicting, anti-craving medication is pivotal in helping them ‘rewire’ their brain away from drugs and alcohol,” says Menzies.

Most health practitioners aren’t qualified to speak on addiction therapy. Addiction specialists are rarely even recognized as a true billable specialty in the medical community. Most became addiction specialists through reading online journals and clinical studies, but Percy Menzies isn’t like most practitioners. This small unobtrusive man is a powerhouse of knowledge and experience on addiction drug therapy. He served as the associate product director for naltrexone with DuPont and is now the President of the Assisted Recovery Centers of America, a small group of offices dedicated to treating alcoholic and heroin-addicted patients with Vivitrol. “Quite simply, the results are astounding,” Menzies says with surprise. “I tell all the patients, I don’t care what works. If I could swing a chicken around your head 10 times and you’d be magically cured, I would do it, because I care about curing patients, not about making money, and not about some philosophical agenda. The truth is, despite so much bad press, that Vivitrol works. It works like a miracle. My clinics have been treating patients for years and if it didn’t work, I wouldn’t use it.”

I had the pleasure of sitting down with Percy Menzies to discuss his knowledge of medical therapy for addiction and current state of the recovery community in America:

Thank you for doing this interview. Now as we previously spoke, you mentioned that Vivitrol is by far the most effective form of treatment for both alcoholism and heroin addiction. Getting right to it, what is the history of the development of Vivitrol?

Before we go to Vivitrol, we need to look at the history of the development of naltrexone almost 40 years ago. Naltrexone was developed for one specific purpose – to be a non-addicting medication to prevent detoxed heroin addicts returning from incarceration or residential treatment from relapsing when they returned home. It is the classic Pavlovian conditioning. The ‘bell’ will start ringing in the form of sights, sounds, people and places associated with past drug use and the fact that the patient has been away from his/her most favorite thing, is going to make the craving even stronger. This is called, “The Deprivation Effect.” Patients released from jails and prisons are 12 times more likely to die of a drug overdose within the first month. Most of us have heard of stories of patients returning home from treatment centers getting drunk at airports on their way home! Nothing is more frustrating for the patient and their loved ones than when relapse occurs within days of returning home.

Naltrexone was the beneficiary of Nixon’s now infamous “War or Drugs.” The Nixon Administration created the Special Action Office for Drug Abuse Prevention (SAODAP) in 1971, which led to the development of naltrexone as the first non-addicting opioid antagonist. Never in the field of medical treatment did we have two drugs at the opposite end of the spectrum approved for the same treatment—the other drug was methadone. You cannot have two drugs so completely antithetical. Naltrexone has been described as a physician’s dream medication while methadone was a product of harm reduction efforts. Naltrexone was FDA approved in 1984. Vivitrol was finally introduced to solve the problem of compliance with oral naltrexone in 2006. Compliance is a major problem in treating any chronic condition and is a particularly difficult problem when it involves basic survival circuits.

The problem is naltrexone/Vivitrol is just not used in the community and the reasons are ideological rather than clinical. Imagine the drop we would see in rates of recidivism and overdoses if just 10% of patients returning home from residential treatment or incarceration were given a Vivitrol shot 3-5 days before discharge.

Can you describe what got you into this line of work and what you found to be obstacles in your struggle to cure alcoholics and addicts?

I prefer the word ‘quit’ rather than ‘cure’ because it is an action word indicative of something you have done on your own volition. I am perturbed by people emphatically saying ‘I quit smoking ten years ago,’ but in the same breath say, ‘I am in recovery for 20 years.’ We have treatments that allow patients to lead near-normal lives without the drugs or alcohol. The combination of the appropriate anti-craving medications and behavioral therapy can allow people to quit for life.

Based on several studies and the fact that naltrexone had been used for almost 10 years, the FDA approved the indication of naltrexone as an adjunct for the treatment of alcoholism in 1994 – 10 years after the approval for the treatment of opioid addiction. No chronic illness that affects close to 20 million people in this country is treated episodically or experientially with complete disregard to clinical evidence, without the aid of appropriate medications, except alcoholism. I describe this as the hubris of people in recovery who claim to be ‘experts’ based on their own ‘cold turkey 12-step miracle’ recovery.

In 2000, I left DuPont Pharmaceuticals and followed my calling to start evidence-based treatment centers that integrated anti-craving medications with relapse prevention counseling. Opening a clinic in St. Louis was no easy task. I was repeatedly reminded that St. Louis is a very conservative city and not open to unconventional treatments, particularly with medications like naltrexone that have been rejected by 12-step and psychology leaders. I had to deal with the dominance of the 12-step groups and the methadone clinics. Somebody once jokingly said that if these two groups were business organizations they would be charged with violating antitrust laws.

Things changed rapidly for the better with the introduction of Vivitrol in 2006, the once-a-month, long-lasting injection of naltrexone. The issue of compliance was over and now we could create a ‘drug free-zone’ within the patient’s brain for a month! Look at it as a monthly vaccine; calming the storm of the never-ending cycle of cravings and withdrawal. This finally allowed the patients to focus on their long-term recovery through counseling and psychiatric services.

The Assisted Recovery Centers of America (ARCA) model worked well because the patient was getting well within his/her natural environment that was filled with cues and triggers. In the past, these led to relapse, but now helped with Vivitrol, the patient could quit. This has to be the goal of every treatment program – extinguish the conditioning that caused and sustained the addiction.

The benefit of this treatment approach is that the patients don’t have to spend weeks in residential treatment. The treatment is individualized and most can go back home in 10-12 days and continue long-term treatment on an outpatient basis. The state is tracking outcomes and at least one study has been published and several more are ongoing.

How well do patients fare at your clinics? Does insurance typically cover the expensive cost of Vivitrol? How long does a patient need to stay on it? What is the treatment regimen and what typically happens after a patient ends their therapy?

The ‘cure’ or ‘quit’ rate is entirely dependent on the patient staying with the treatment regimen. We tell our patients that if they continue on the medications like naltrexone or Vivitrol, attend counseling sessions and are drug or alcohol-tested, relapse is not likely. Unfortunately, patients are very ambivalent about recovery. They fall victim listening to the wrong voice (such as anti-medication, 12-step sponsors) and stop taking the medications, stop attending counseling sessions, often leading to relapse while trying to stay sober in AA.

Our formal program is treating the patient for six months or longer and keeping them on naltrexone or Vivitrol for a year or longer.  We are pleasantly surprised that just about every insurance company is paying for Vivitrol so the rumors that it is inaccessible are entirely false. The issue of the cost of the Vivitrol is most often raised by counselors and therapists opposed to using any medications. Be suspicious of this. We have medications and therapies that can cost tens of thousands of dollars and yet we find ways to pay for those drugs. Why is it that we in America want to treat addictions on the cheap? We have to change our mindset. There are several well-designed studies on Vivitrol that show better treatment outcomes and, yet, the ideological barriers trump evidence-based treatment.

There are those, such as Dr. David Sinclair, “The Godfather of Naltrexone,” who claim that drinking on naltrexone is much more effective than using it for abstinence. Do you agree with him? What do you find occurs in patients who do drink on your therapy?

I have known Dr. David Sinclair for many years and don’t agree with his approach. The patients that come to our clinics have gone through other programs with little to no success. Most of the patients have attempted to moderate their drinking with no success. Controlled or social drinking for a patient who has developed full-blown alcoholism is an oxymoron. AA is correct on this point. Most of my patients started on naltrexone and will test the drug by either drinking or using opioids. They will come back and admit that they did not experience a high from the alcohol or the heroin had no effect. We tell our patients that they should consider alcohol or opioids as causing an ‘allergic’ reaction, similar to AA. Using alcohol or opioids will prime the pump and you are likely to breakout into drinking or using drugs. We convince our patients that they can lead a very normal, healthy life without alcohol or drugs being the center of gravity. Read More “the fix”…

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