TAMPA — Once known as the pill mill capital of the nation, Florida now faces another problem: Helping users kick their addiction to prescription pain pills and other opioid drugs including heroin.

Now patients under court order to get treatment can get a costly medication for free at a local drug rehabilitation clinic.

Last week, Tampa's Drug Abuse Comprehensive Coordinating Office (DACCO) started administering Vivitrol to some patients. Vivitrol, the brand name for naltrexone, blocks the effects of opiates and alcohol cravings, and is given as a single, monthly shot.

The drug has been on the market for about five years, said Mark Fontaine, director of the Florida Alcohol and Drug Abuse Association. But its wholesale price is about $1,000 per dose before treatment and administrative costs.

"Nobody could afford it that needed it," said Mary Lynn E. Ulrey, the Tampa clinic's CEO.

Since the Florida Legislature appropriated about $5 million for the drug last year, clinics throughout the state can seek funds to administer naltrexone at no cost to the court-ordered patient. DACCO was the first in the state to receive approval, and Pinellas' Operation PAR is applying to participate in the program.

"Right now we're starting it with people that are in drug courts, people that are on county probation, people that are on state probation," Fontaine said. His group is clarifying whether the coverage will include Florida Marchman Act patients, who are ordered to seek treatment after family members file petitions in civil court seeking help.

On Wednesday, the first day of the free treatment at DACCO, about 20 people were waiting to learn if they were eligible. Dr. Lawrence Wilson, a medical review officer at DACCO, said the screening process typically takes about a week following a two-week withdrawal period.

Patients who agree to take Vivitrol must first undergo the withdrawal period because the shot attacks the receptors that make opiates so addictive.

"The receptors shrink," Wilson said. "They shrivel up. Their numbers decrease. And that whole process of keeping that reward system turned on shuts down."

If patients haven't already undergone withdrawal, the drug will send them into it, which can be a significant shock to the system. It's one of the reasons Wilson said law enforcement supports Vivitrol. Unlike drug therapies like methadone, it has little to no street value, because on the street "it'd be the worst thing an addict would want."

Though methadone is commonly used to stabilize opioid addiction, it — unlike Vivitrol — is an opiate itself, Wilson said.

"Methadone is just changing the drug of choice," he said. "Street opiates, prescription pain pills, they are very quickly acting with a high intensity, but short acting. So there's a good feeling for a short period of time. And they dissipate. And you have to go get more to get it back again."

Methadone lasts longer than other opiates, and comes on more slowly so addicts don't get an intense and immediate effect. Vivitrol attacks an opioid addict's overall dependency.

"What you have is the ability to take somebody who has long-term addiction and give them an opportunity to get into treatment and get into their life without that constant urge to use," Wilson said.

Fontaine agreed, calling it a "fundamental change."

"For opiate-dependent people, relapse rate in the first year is really high," said Dr. Jason Fields, DACCO's medical director. "This is a tool in their tool belt to help better engage substance abuse treatment services and get the most out of their treatment."

Florida experienced a surge of prescription pain-killer related deaths in the early 2000s. Federal authorities said 98 of the country's 100 highest oxycodone-prescribing physicians worked in Florida, a statistic that moved state and local officials to toughen laws and penalties for improper prescription practices and doctor-shopping by patients seeking drugs.

Since then, the U.S. Centers for Disease Control and Prevention reports a dip in state opioid overdoses, but Ulrey said Florida still ranks second-to-last in the country for providing substance abuse treatment.

"The resources available are so limited that when something like this happens, it's real exciting," Ulrey said.

Fontaine said about 15 state clinics had applied to administer Vivitrol via state funding since the application process opened last week.

"Addiction costs this state a lot of money,'' Fontaine said, "and if this tool can help change lives then it will protect public safety, it'll reunite families and it will result in reduced cost to Florida."

Contact Rachel Crosby at rcrosby@tampabay.com or 813-226-3400. Follow @rachelacrosby.