Last July, Nancy Haggerty, a reporter for The Journal News, based in Putnam County, New York, interviewed John DeFonce as part of a story about former athletes from the area who had become addicted to heroin via prescription painkillers for sports injuries. At the time, DeFonce was in treatment at St. Christopher’s Inn in Garrison and was not identified by last name in the story, which didn’t run in print until October 1. Less than two weeks later, the paper had to report on his death. He was on a weekend pass from a halfway house owned by St. Christopher’s. His parents found him unresponsive on a couch and called 911. The cause of his death is pending results of the autopsy.

Formerly a star high school football player in the area, DeFonce had first become addicted to prescription opioids.

DeFonce had been prescribed pain medications after a high school football injury, according to The Journal News, which reported that after his physician refused to give him more prescriptions, he began buying drugs on the street, and soon went to heroin. “I bounced from rehab to rehab,” he said.

At one point he was arrested and accused of credit card fraud, and checked himself into a treatment program in Florida, which meant he had jumped bail. “My lowest point was sitting in that jail cell,” he told The Journal News. “That’s when I decided I wanted to change.”

Putnam County, called “where the country begins” by many former New York City residents (and where the editor of ADAW lives), has a drug court, headed by Judge Jim Reitz, who believes in allowing offenders one chance at treatment.

St. Christopher’s starts Vivitrol

Stephen Shapiro, M.D., medical director of St. Christopher’s Inn, didn’t want to talk about a “particular client for confidentiality reasons.” However, he did say that Phase 1 of treatment involves a 30-day stay, with no one allowed out on passes. Phase 2 involves some privileges, but it’s still “highly structured.” By the time someone reaches Phase 3 — the phase DeFonce was in — “we’re hoping they’re out in the community more, out on weekend passes,” he said. “Even when my own mother talked to me on the phone about this, she said, ‘How could you let him go out on a weekend pass?’” But that is the position many treatment programs are in, after weeks and even months of treatment — they discharge patients who seem ready, and some patients relapse.

St. Christopher’s uses buprenorphine, with a maximum dose of 8 milligrams, said Laurel McCullagh, director of nursing at St. Christopher’s. “Ideally, we like to see people free of substances,” she said. “But I’m more excited about Vivitrol.”

The plan in the future is to taper patients off of buprenorphine, and then give them a Vivitrol injection when they leave, said Shapiro. “Then, they need to get another shot every month,” he said.

The sales representative for Alkermes, Michael Peluso, has been “very proactive,” said McCullagh. They have helped with getting prior authorization for Vivitrol, which is “very expensive,” she said. “He is passionate about this, a wonderful guy.” An email to Peluso was not returned by press time.

Patients also like being on Vivitrol, said Shapiro. “They feel no cravings,” he said. Shapiro has given eight Vivitrol injections in the past two months, he said.

More than medication

But Vivitrol and buprenorphine “are not the total answer,” said Shapiro. “They’re part of a treatment program. I still believe that Twelve-Step programs are the bottom line to success. So you have to combine Vivitrol with AA and NA meetings.”

Currently, St. Christopher’s has 180 beds and is full. The waiting list is about two weeks long. An unusual program in one way, St. Christopher’s also operates a shelter where patients can live while they are attending outpatient treatment at the program.

“We’re 106 years old,” said Shapiro of St. Christopher’s. “For the first 100 years, alcohol was the primary drug of choice. Now, it’s opioids.”

And there aren’t many resources in Putnam County. Arms Acres, in Carmel, is, like St. Christopher’s Inn, always full. “When I first came here in 1998, there were 129 beds — now there are 162,” said Patrice Wallace-Moore, CEO of Arms Acres and vice president of Liberty Management Group, which owns Arms Acres. “But there’s still such a need,” she told ADAW. “We’re always trying to figure out how we can reach more people.”

In New York state, managed care companies now know that they have to abide by parity rules, and must pay for detoxification, she said. “There was a time when it was considered not life-threatening, and people on opioids were not allowed in treatment programs,” she said. Wallace-Moore credits many of the mothers who lost children to opioid overdoses for the attorney general’s lawsuit enforcing parity (see ADAW, March 31, 2014).

NIMBY and methadone

Liberty would open methadone programs in Putnam County if there were community support, said Wallace-Moore. “The problem is that many people in the community do not agree,” she said. “In order for an OTP to be allowed in a particular community or county, state regulations require that it receive community support. There is a lot more resistance in the community than there is in the treatment field.”

Liberty just opened an OTP in Plattsburgh, where there was none. “We are attempting to put one in Troy, but met with widespread resistance from the community,” said Wallace-Moore. Meanwhile, Arms Acres does use buprenorphine and Vivitrol, although problems with reimbursement for Vivitrol exist.

“The medications are going to be different for each individual, and the more options that you have, the better for the community,” said Wallace-Moore. “But medication alone isn’t good. The key word is treatment.”

In the meantime, The Journal News published an editorial noting that the number of methadone programs was going down in the area, and calling for more support for treatment. It also published a story detailing social media responses to the death of DeFonce, many of which showed that local residents blame drug users for their own problems. Siting a new treatment program in Putnam County would probably include convincing the residents that their own friends and family members are the ones who would need it.