Recently, the Criminal Justice Coordinating Council heard a presentation from a pharmaceutical company about Vivitrol, a medicine used to treat those in drug rehabilitation. Boyle County Jailer Brian Wofford said the detention center is considering its options for MAT — medically assisted treatment.

Right now, state inmates at the jail in the Substance Abuse Program (SAP) who qualify are treated with Vivitrol through an extended-release injection that lasts 30 days. Dennis Britton with Alkermes, a biopharmaceutical company, guided the council through marketing material about the treatment. He said 700 prison and jail programs in 41 states are using it.

Britton said the biggest issue with Vivitrol is “that you have to detox. That’s the biggest attraction of buprenorphine or methadone — you don’t have to detox. But once we get people through that and cross that line, you never have to go back again. But it’s a challenge.”

Vivitrol is a brand name of naltrexone, an opioid antagonist that works by blocking opiates’ effects and curbing cravings. Patients must go through detox first before taking the drug, which can be started only after all opiates are out of their system. Some say for this reason, among others, it’s the perfect treatment for inmates.

In Kentucky, Britton said of the 23 SAP jails, “probably 20 are using Vivitrol right now.”

Lisa Lamb, director of communications with the DOC, said the department has 21 jails that utilize Vivitrol, and all are DOC funded.

Tanith Wilson — previously the SAP coordinator at the jail who is now director of operations for Boyle County with Shepherd’s House treatment programs —  said qualified state inmates receive two shots before being released. One injection is given about a month before release, and the second just days before. Since the shot lasts a month, “they have a whole month to get everything in order” for their third shot, since the medication is covered by Medicaid, she said.

The jail is also in the process of hiring a mental health provider and a caseworker, who will work with a nurse “and say, ‘Here’s the programs we’re going to implement for reentry … where do we need to start providing the shot in the treatment?’” Wofford said.

He said the caseworker will also help inmates get connected with further therapy after their release, as well as information they need on how to get set up on Medicaid so they can continue the injections.

James Hunn, who has worked with Shepherd’s House through Circle of Hope, is going to be the jail’s re-entry coordinator, leading classes and other processes for those who battled their addiction on the inside, in order to prepare them for life on the outside.

Wilson said some clients at Shepherd’s House are already on Vivitrol and are doing well with it. In her opinion, the injection is a much better treatment than Suboxone. “On Suboxone, they can wake up and say they feel like using, they don’t take the pill and they score (drugs). But there’s no option for that when they get the shot, and it lasts for a month.”

Suboxone and methadone both contain opiates. “So the injection — they can’t sell it. There’s no potential for for diversion. And you don’t have a bunch of high people sitting around in jail, either.”

Wofford agreed. But so far, he says the jail doesn’t have the money to pay for Vivitrol for county inmates. The shots cost around $1,500 each.

Britton said samples may be used until the jail knows how it will handle implementing MAT for county inmates. He said there are cases where the DOC is paying for county inmates to be treated with Vivitrol.

Lamb said three of the 21 jails with DOC-funded substance abuse programs do pay for county inmates to be treated with the injection.

Wilson said Suboxone is “one of the most abused drugs out there — it’s right up there with heroin and meth; it’s used as a street drug a lot.” She said many who come to Shepherd’s House for help say “Suboxone is their drug of choice, and they’re buying it off the streets.”

Jerod Thomas, Shepherd’s House’s president and CEO, said, “You have to be careful throwing that out there — you can isolate half of the room. The thing is for everybody to have the facts, then make the decision.”

Thomas then added, “People actually show up at my treatment center and their drug of choice is Suboxone, and I’m trying to get them off of it. I don’t have anyone on Vivitrol at my place trying to get off of it.”

Commonwealth’s Attorney Richie Bottoms said, “I’ve seen someone on Vivitrol overdose while they’re on it, because it does happen and it makes for an extremely dire situation.”

Britton asked Bottoms for more information about the situation. Bottoms didn’t know all of the specifics, but said that “they may have not bought into their treatment. They were hoping the Vivitrol in and of itself would fix things, and it served actually the opposite effect — made it worse.”

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the U.S. Department of Health and Human Services, patients on naltrexone may have reduced tolerance to opioids and may be unaware of their potential sensitivity to the same or lower doses that they used to take. SAMHSA says, “If patients who are treated with naltrexone relapse after a period of abstinence, it is possible that the dosage of opioid that was previously used may have life-threatening consequences, including respiratory arrest and circulatory collapse.”

Britton said, “So overdose is common with opioid use, right, so is someone more or less likely to overdose on Vivitrol — we don’t have any data on that, we’ve never researched that …. I will say it’s been out since 2006. When the FDA gets increased or overwhelming reports of effects from any medication, they either pull if off the market or make the company implement some kind of risk litigation strategy, and that’s not happened.”

Britton said there hasn’t been “an increase or a wealth of reports of the FDA saying all these patients are overdosing while on Vivitrol. Has it happened? Maybe it has, and probably it has …” He said the therapy part of treatment is critical. “If someone understands their disease and illness, they’re making positive steps toward their recovery, then there’s a medication that can help along the way, instead of those overwhelming cravings taking away from it, working against the positive work they’re trying to do,” Britton said.

He said studies show the drug can reduce cravings by 55%.

Boyle County Judge-Executive Howard Hunt asked how long of a duration people are usually on Vivitrol; Britton said that depends.

“It’s more of a recovery question than it is a medication question. How long does it take someone to replace the people, places and things that got them into trouble? On average, we see about a year. Commercial insurance and Medicaid will cover it indefinitely. Some cases, which are rare, people are on it for two, three, four, five years.”

The question was asked how someone is treated after a bad car wreck who had to go straight into surgery; how do medical professionals know they are treating someone who is on an opiate blocker, which would render most pain medicine useless?

Britton said the company offers wallet cards or ID tags patients can wear to let emergency workers know they’re on a blocker. Once medical personnel know the patient is on it, “the medical community can override it in the hospital” with general or local anesthesia, he said.

Britton said in some criminal justice systems Alkermes has worked with, “Some give inmates time off of their probation for every month they’re on Vivitrol, to incentivize them rather than punish them. Every six months an inmate is on Vivitrol, they get 90 days off probation.”

Wofford says he hopes to have the mental health care professional and caseworker positions in place by next month.