Evidence has shown that providing comprehensive, both jail- and community-based treatment to opiate-addicted offenders significantly reduces relapse to opioid use as well as criminal recidivism. Individuals who enroll in an opioid treatment program (OTP) under legal pressure (i.e. mandated as a condition of pretrial release or probation) have outcomes as favorable as opiate addicts who enroll in an OTP voluntarily. Several studies have found that opioid-addicted inmates who start medication-assisted treatment (MAT) while in jail and then continue it after release have improved offender outcomes than those who only start MAT after their release or those who only receive psycho-social support in prison.
A new opioid treatment program called Vivitrol, launched in February this year, offers Madison County Jail pretrial inmates suffering from opiate use disorder a double chance of turning their lives around - a steady road to long-term recovery and the opportunity to get early release. According to Tony New, Madison County's chief probation officer, only pretrial inmates have been allowed to enter the Vivitrol program so far and that is partly because participants are required to be opiate- or alcohol-free for minimum 7 days before starting treatment with naltrexone, the active ingredient in Vivitrol. Tony New also emphasized the importance of the screening process and said that, to date, he has screened some 70-80 inmates for the program.
Incarcerated opiate addicts who agree to enter the Vivitrol program are released early, but after release, they are required to continue treatment with Vivitrol at a healthcare center that offers extended-release injectable naltrexone for the prevention of relapse to opiate use following detox. Anderson Center of St. Vincent’s Regional Hospital, Jane Pauley Health Center, Open Door Health Services and Aspire Indiana Health are among the health care centers that offer treatment with Vivitrol in Madison County, Indiana.
A total of 20 opioid addicts has entered the Vivitrol program since February. Participants are intended to undergo treatment with the prescription injection medicine monthly, for a period of 9-12 months. Those who stop seeking medication-assisted treatment that combines intramuscular injections with the opioid antagonist naltrexone and other opioid recovery programs i.e. counseling are turned back to the drug courts and often they return to jail. The first injection with Vivitrol is supplied by Alkermes Pharmaceutical Manufacturing and Global Biopharmaceutical as a free sample and is administered by S&R Medical while the opioid-addicted offender is still in jail, just before release.
Naltrexone is a decade-old non-addictive, non-narcotic medication approved by the FDA for both the treatment of alcohol addiction and the prevention of relapse to opiate addiction, thanks to its opioid blocking properties. Unlike other MATs such as full mu opioid agonist methadone and partial opioid agonist buprenorphine ( Suboxone), naltrexone is an opioid antagonist with little ( if any) opiate agonist activity that blocks the effects of opiates by competitive binding at opiate receptors. Because it's not a narcotic, naltrexone cannot be abused, so the monthly administration of naltrexone is not associated with the development of addiction or tolerance.
Vivitrol is supplied by Alkermes plc as a microsphere, extended-release formulation of naltrexone for suspension. The manufacturer warns that using opioid street drugs or opioid pain relievers even in amounts used before treatment with Vivitrol can increase the risk of accidental opiate overdose, severe injury, coma or death. To avoid sudden opiate withdrawal symptoms, an individual must stop taking any opiates including Suboxone and methadone, for minimum 7-14 days before starting relapse prevention treatment with Vivitrol.
Madison County's chief probation officer Tony New, who supervises participants in the Vivitrol program said that the cost of monthly treatment with naltrexone is expensive, from $750 to $1,000 per shot. Several organizations have been visiting inmates at Madison County Jail to sign them up for HIP 2.0 or Medicaid, both of which cover Vivitrol injections. " Recovery Works", a specialized program operated by the Family and Social Services Administration covers the cost of treatment with Vivitrol, up to $2,500 for every alcohol or opiate user released from jail.
Police chiefs, judges, and governors have already helped launch over 100 programs that combine Vivitrol treatment and counseling across 30 states. Vivitrol revenue rose 53% in 2015 to more than $144 million as the Medicaid segment of sales nearly doubled.