Sheriff pushes costly addiction treatment for prisoners in Scott County

McClain is working with state and local officials to bring a costly medication called Vivitrol into the county jail in hopes of keeping offenders — particularly those already infected with HIV — from relapsing once they are released.

Vivitrol is an injectable form of the drug naltrexone. Addiction specialists say it blocks cravings for heroin and other opiates, such as those found in the prescription painkiller at the center of the Scott County outbreak.

Vivitrol is already used in court-ordered programs, as an alternative to locking up heroin users, in 27 of Indiana’s 92 counties. Scott County would be first to administer it to prisoners before an addict is released.

“We have people who are serious about kicking their drug habit when they’re in our jail, but they don’t stay that way when they’re back on the streets,” McClain said. “This is the first step to helping them stay clean.”

An outbreak of HIV, detected late last year in the small city of Austin, hit 170 cases by June. Almost all were tied to intravenous drug users sharing contaminated needles to inject the painkiller Opana.

Approved in injectable form in 2010 by the U.S. Food and Drug Administration, Vivitrol has won guarded praise from addiction specialists. Unlike the commonly used methadone, which mimics the effects of opiates, it blocks cravings for the opiate high.

But it’s expensive, which has limited its use in the criminal justice system. The drug retails for $800 to $1,200 per injection.

Some private insurers cover part of the cost. Many don’t.

A breakthrough for Scott County came with the help of state Public Health Commissioner Jerome Adams, who helped convince the drug’s manufacturer, Alkermes, to launch a pilot program in the jail, providing the first doses at little cost. The company has done the same in at least 40 jails around the nation.

A typical Vivitrol regimen, with the drug administered every four weeks, lasts 8 to 12 months. So state public health officials have agreed to let taxpayers pick up part of the cost.

They’re working with McClain to enroll prisoners coming out of jail into the Healthy Indiana Plan 2.0, the state’s Medicaid program. The plan will pick up the bulk of the cost, reducing prices for those enrolled in the program to just a few dollars.

Earlier this year, Rep. Wendy McNamara, R-Mount Vernon, pushed to give local judges more authority to use Vivitrol as part of court-ordered programs, but lawmakers balked at its cost.

McNamara sees it as long-term investment. “If they can stay out of jail, the state benefits because we’re not having to pay to incarcerate someone," she said.

Scott County prosecutor Jason Mounts is cautiously hopeful.

“Our goal isn’t to lock up all the drug addicts in our county,” he said. “It’s to get more of them into treatment and back into society as productive citizens.”

He is working with local judges to set up protocols for court-ordered use of Vivitrol as part of a larger treatment program that includes counseling and support. They’re encouraged by other courts - such as Hamilton County’s — that use now Vivitrol as a sentencing alternative.

“It’s not a miracle drug, but it curbs the craving enough that they can focus on their counseling and treatment,” said Hamilton County deputy prosecutor Amy Summerfield. “It gives them time to spend on underlying issues, rather than deal with cravings on front burner all the time.”

The jail piece is seen as key. If McClain succeeds in resolving the cost issue, other counties may follow suit.

Penny Rader, a Boone County probation officer who oversees addicts in court-ordered drug treatment programs, said Vivitrol can only be given to someone who’s gone through detoxification, which can take 5 to 10 days.

“That’s been our biggest stumbling block,” Rader said. “Going through detox is very, very difficult. Some people are just unwilling to go through it.”

McClain agrees but says prisoners “detox in our jail whether they want to or not."

It may be September before the Vivitrol program gets underway in Scott County.

McClain said he knows it won’t be a panacea for the problem that has ravaged his community.

“We didn’t get here overnight,” he said. “And it will take a long time and a lot of work to get ourselves back to where we need to be.”