Fighting Opioids Prisons (copy)

A nurse at an addiction treatment center in Illinois holds a syringe used for Vivitrol, which is used to prevent relapse in opioid abusers. AP file photo.

A new program will allow some El Paso County inmates addicted to opioids to receive an injection that could help keep them from relapsing once they are back on the street.

The jail’s health care provider, Armor Correctional Health Services, will begin offering a dose of Vivitrol to some inmates during their final month of incarceration. The drug helps people who struggle with addiction by blocking the receptors in the brain that allow them to experience the pleasure of a high from prescription painkillers or heroin.

Once released, the addict will be referred to a local health care provider to continue to get a monthly shot and counseling, with the goal of staying clean.

Vivitrol is used by many in the 4th Judicial District Recovery Court, which offers some felony offenders an alternative to incarceration if they agree to undergo substance abuse treatment for at least two years.

Officials say the program has the potential to help combat an epidemic of opioid dependence and overdoses while reducing recidivism among those who cycle in and out of jail due to addiction-driven crimes.

Of the 560 opioid-related deaths in Colorado in 2017, 92 were in El Paso County.

“Typically, when you get out of custody, one of the first things you want to do as an addict is use,” said Magistrate Daphne Burlingame, who overseas Recovery Court. “This pilot project is, I think, going to be helpful to allow people who are just getting out of jail to have a little help in being able to stay clean, especially in that very difficult first few weeks or months.”

Doses of Vivitrol retail for more than $1,000 each. But the drug’s manufacturer, Dublin-based Alkermes, will provide injections to the jail’s health care provider for free, said Vickie Freeman, Armor senior vice president.

Alkermes supplies Vivitrol to hundreds of correctional facilities across the country, including other jails served by Armor.

Many of those who receive their first injection at the jail will not have to pay for follow-up injections, which are covered by Medicaid, Freeman said.

Officials are not sure exactly how many people the program will serve. The screening process for Recovery Court will identify some candidates, and Armor might find other inmates who struggle with opioid addiction and could benefit from the drug, she said.

The Recovery Court has about 180 participants, all of whom have criminal histories that are connected to their drug addiction, Burlingame said. She estimates that about half of those offenders have an opioid addiction.

However, upon their release, those with opioid dependence don’t always choose to use Vivitrol or other drugs that can help them overcome their addiction. Such drugs, which fall under the umbrella of what practitioners refer to as “medication-assisted treatment,” also include buprenorphine and methadone.

There are some downsides to Vivitrol, which critics have dismissed as a Band-Aid that’s not a true cure for addiction.

If someone who’s received the shot tries to use large amounts of opioids to overcome the drug’s effects and get high, “serious injury, coma or death” can result, according to Vivitrol’s website. Some common side effects include nausea, headache and vomiting. Patients can also experience depression and suicidal thoughts.

Those who wish to receive the injection will be required to sign a consent form outlining those risks, per an agreement establishing the program that was approved by county commissioners on Tuesday. Prospective participants will also undergo medical screening, which will involve lab work and a review of their health history, Freeman said.

Insurance coverage of Vivitrol can be spotty on private plans, so continuing treatment could be expensive for those who don’t have Medicaid, said Dr. Kevin Snyder, co-founder of Achieve Whole Recovery, the Colorado Springs-based treatment provider that has signed on to administer follow-up injections to program participants.

Still, Snyder said that Vivitrol is a good option for inmates who are addicted to opioids and about to be released from jail.

A patient must have fully detoxed from opioids before they receive a Vivitrol injection — which makes the drug particularly useful in a jail setting, where people who struggle with addiction are forced to go without drugs and alcohol for extended periods. Plus, the medication isn’t taken daily, like methadone, so there’s less opportunity for a patient to miss a dose and fall off the wagon, he said.

“With that shot right out that door … you’re going to really empower that person to be able to make a lot better choices and resist some of the potential triggers and temptations,” he said.

The new program is viewed as a positive step for Armor, which initially struggled to meet its contractual obligations when it began serving the county in 2017. The county threatened to fine the Miami-based company that fall after an audit found a backlog of inmate sick calls, lapses in documentation of staff training and other problems. But the Sheriff’s Office and the health care provider have said that the issues were corrected in a timely manner.

Alkermes has been criticized in media reports for aggressively lobbying and efforts to market Vivitrol to criminal justice systems, while some medical experts have said that other drugs may be safer or more effective for those overcoming addiction.

But the manufacturer says Vivitrol is effective and has been used to treat more than 300,000 patients since it was approved. A 2016 study in the New England Journal of Medicine found that the injections helped prevent relapse among offenders, said Sherry Feldberg, Alkermes’ director of public affairs and product communications.

“Our marketing practices are ethical, legal and appropriate. With the growing epidemic of opioid dependence, multiple stakeholders across public health and public safety are directly involved with individuals with opioid dependence and the treatment process,” Feldberg said in an email.

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