Drug Counselors Warn Of Statewide Crisis Threatening Addicts

First report in a two-part series

WEYMOUTH, Mass. — Drug counselors are warning of a statewide crisis threatening drug addicts who have suddenly lost their supply of a new anti-addiction drug.

The medication is called Vivitrol. The prime prescriber and supplier of the drug is a statewide chain of medical centers that collapsed last week after its owner, Dr. Punyamurtula Kishore of Brookline, was indicted by a state grand jury.

I visited the last center to close its doors.

"As of 5 o'clock today we are officially closing our doors."

That's what they're telling callers, but upstairs at the Weymouth Medical Practice it's not at all clear what "officially closing" means. After all, the staff hasn't been paid in eight weeks and they haven't heard from the owner since he stopped paying them. Like medical assistant Joe Desroche, they're not sure what to tell people who are calling in desperation for another source of the anti-addiction medication.

"What are they saying?" one worker asks the other.

"Just...nothing. Just, 'Why? Why?' " he replied. "I mean, they don't know where to turn. They don't know what to do. And I don't know what to tell them anymore."

"Because there really aren't a lot of options for getting Vivitrol, are there?" I ask them.

"There's not."

Drug Addicts Losing Access To Anti-Drug Medication

From 30 treatment centers across the state, the corporation known as Preventive Medicine Associates had collapsed to just one, here in Weymouth. On this day, it was an hour and a half from closing its doors, too. And because these treatment centers were the state's predominant supplier of Vivitrol, the heroin and OxyContin addicts who were its patients have suddenly been cut off.

Like Josh.

"Where are you going to go?" I ask him.

"No idea. I'm gotta find that out. It's a shame though. Horrible. A bunch of drug addicts are gonna be out on the street, you know what I'm saying," Josh replied.

"Over 1,000 of them will be out on the street, Monday," one woman said.

"Well, people it works for probably know better. I know this guy. How you doin' buddy," Josh said, greeting a young man named Joe who is sitting beside him in the waiting room.

Joe is an addict who is with his mother, who just chimed in. Like Josh, Joe and his mother, addicts and their parents requested that we not use full names to protect their reputations.

"The Vivitrol shot works awesome, it's just really, it's just sad," Joe's mother said.

"You're worried that you're not going to find a supply of it?" I asked his mother.

"Yes, very worried. I'm worried for the 1,000 kids that will be on the streets on Monday morning with no place to go," she said. "It's a sin. The man should be ashamed of himself. He should be in jail. He just ruined all these lives."

Dr. Kishore's Medical Center Empire

Kishore built a mini-empire tied to the locally manufactured drug Vivitrol. The media-savvy Kishore had been considered a rising star in the field of drug addiction research and treatment. He operated the National Library of Addictions and the American College of Addiction Medicine.

Over the past four years, according to a state prosecutor, he has brought in $20 million in insurance payments from MassHealth alone. When Kishore came under investigation for fraud, MassHealth withheld his reimbursements, and the bottom started falling. After he was indicted last week on charges of paying kickbacks and bribes, the attorney general suggested a rolling wave of fraud charges would soon follow.

All that remains of Kishore's comet is the acclaimed success of Vivitrol itself, which nurse practitioner Anna Steinkrauss is preparing to inject into the left buttock of a 27-year-old addict.

First approved in 2006 for the treatment of alcohol addiction and cleared for the treatment of opioid addiction last year, Vivitrol is known as an "opiate receptor antagonist." That means addicts who get one shot a month can't get high from such drugs as heroin and OxyContin. And Vivitrol users say they have increasingly diminished or no cravings whatsoever for opiates.

Steinkrauss said Vivitrol itself is not addictive.

"So you will not have withdrawal symptoms. Methadone or Suboxone, if you stop taking those treatments you will have withdrawal from it because there is an opiate component to them."

This one office in Weymouth alone was getting 700 to 1,000 patient visits a month. That came to a crash last Friday at 5:00 p.m. At other clinics in the chain, many patients had already discovered the news as they showed up at closed doors, behind which their charts are locked up and unavailable.

"With a patient population of substance abusers ,trust is so much harder to build. And when you have that trust and they've gained that confidence and that comfort in you, that abandonment is just that much stronger. And it's just heartbreaking. I've been crying with patients all week. It's just horrible," Steinkrauss said.

Mass. Officials Concerned About Possible Relapses

In a health alert last Friday the Massachusetts Department of Public Health expressed concern about the increased possibility of relapses and the high risk of overdoses.

The state said it is working on finding providers who offer Vivitrol and would give priority to patients of Kishore's clinics.

But the staffers here in Weymouth say they have already discovered that the few alternative programs are at full capacity, with full waiting lists as well.

Next to the poster board, where staffers were taking down thank you letters and obituaries of former patients, Jen Ulich was pointed.

"We're afraid to read the obituaries because we're afraid of how many patients are going to die," Ulich said.

These staffers accuse Dr. Kishore of abandoning that care.