Oct. 17, 2016 photo shows the exterior of Sheridan
Correctional Center in Sheridan, Ill. Sheridan is among U.S.
prisons that are experimenting with a high-priced monthly
injection of the drug Vivitrol that could help addicted
inmates stay off opioids after they are released.
— U.S. prisons are experimenting with a high-priced monthly
injection that could help addicted inmates stay off opioids after
they are released, but skeptics question its effectiveness and say
the manufacturer has aggressively marketed an unproven drug to
A single shot of
Vivitrol, given in the buttocks, lasts for four weeks and
eliminates the need for the daily doses common with alternatives
such as methadone. But each shot costs as much as $1,000, and
because the drug has a limited track record, experts do not agree
on how well it works.
Vivitrol could save money compared with the cost of locking up a
drug offender — about $25,000 a year for each inmate at the
Sheridan Correctional Center, 70 miles southwest of Chicago.
Dr. Joshua Lee,
of New York University's medical school, said more evidence is
needed to determine whether the medication can help substantial
numbers of people and whether it's worth paying for, but the early
results are encouraging.
good, and for some of us, it feels like the right thing to
do," said Lee, a leading researcher on the treatment.
emerging as the nation searches for ways to ease an opioid
epidemic that affects more than 2 million Americans and an
estimated 15 percent of the U.S. prison population. Many experts
view prisons — where addiction's human toll can be seen most
clearly — as a natural place to discover what works.
had already served prison time for nonviolent crimes when he was
ordered into treatment for a heroin addiction by a judge who
suggested Vivitrol. Three months later, the 36-year-old from
Centerville, Ohio, is clean and working full time as a cook.
this Oct. 17, 2016 photo, inmate Joshua Meador speaks about
addiction at Sheridan Correctional Center in Sheridan, Ill.
Meador, a recovering heroin addict, hopes to get into a
Vivitrol program at Sheridan before his release in January.
U.S. prisons are experimenting with the high-priced monthly
injection that could help addicted inmates stay off opioids
after they are released.
He now suggests
the medication to other addicts.
have cravings," Wolf said. "I see how much better life
is. It gets better really fast."
receptors in the brain's reward system, blocking the high and
extinguishing urges. In some programs, prisoners get an injection
before release, then follow-up shots from any clinic.
researchers have recognized addiction as a relapsing brain disease
with medication an important part of therapy. But most jails and
prisons reject methadone and buprenorphine, the other
government-approved medications for opioid addiction, because they
are habit-forming and can be abused.
Just ask Joshua
Meador, 28, an inmate at Sheridan who hopes to get into the
Vivitrol program before his release in January. Before
incarceration, he abused both older treatment drugs. When given
take-home doses of methadone for the weekend, he would sell them
"When I'm on
Vivitrol, I can't get high," he said. The drug has no street
value or abuse potential.
couldn't design something better for the criminal justice
system," said David Farabee of the University of California
at Los Angeles, who leads a Vivitrol study in a New Mexico jail.
"There's been pushback with other medications, people saying,
'We're just changing one drug for another.' That argument goes out
the window when you're talking about a blocker" like Vivitrol.
Oct. 19, 2016 photo taken at Family Guidance Center, an
addiction treatment center in Joliet, Ill, shows the
packaging of Vivitrol, a high-priced monthly injection used
to prevent relapse in opioid abusers. U.S. prisons are
experimenting with the medication, which could help addicted
inmates stay off heroin and other opioid drugs after they
Prison systems in
Illinois, Vermont, Wyoming and Wisconsin are trying the drug on a
small scale. Michigan is offering Vivitrol to parolees who commit
small crimes, if addiction is the reason for their new offense.
The federal Bureau of Prisons ran a field trial in Texas and plans
to expand the program to the Northeast next year. The drug's
manufacturer hopes prisons will be the gateway to a larger market.
Also known as
extended-release naltrexone, the medication won Food and Drug
Administration approval for alcohol dependence in 2006 and in 2010
to prevent relapse in post-detox opioid users.
The evidence for
giving Vivitrol to inmates is thin but promising.
In the biggest
study, sponsored by the National Institute on Drug Abuse, about
300 offenders — most of them heroin users on probation or parole
— were randomly assigned to receive either Vivitrol or brief
counseling and referral to a treatment program.
After six months,
the Vivitrol group had a lower rate of relapse, 43 percent
compared with 64 percent. A year after treatment stopped, there
had been no overdoses in the Vivitrol group and seven overdoses,
including three deaths, in the other group. The results, published
in March in the New England Journal of Medicine, have been
promoted by the drugmaker, Ireland-based Alkermes, as it markets
Vivitrol to U.S. correctional systems.
Yet addiction is
stubborn. When the injections stopped, many in the study relapsed.
A year later, relapse rates looked the same in the two groups.
suggest six months wasn't enough," said Lee, the lead author.
T.J. Voller was a
Vivitrol success story — until he wasn't. After Vivitrol was
approved by the FDA, Voller talked about getting the shot with The
Associated Press and Dr. Sanjay Gupta in a CNN segment. The
30-year-old was back at work and seemed proud of his recovery. But
after 10 months on Vivitrol, he died of a heroin overdose.
alone for the weekend and picked up that needle one last
time," said his mother, Kathi Voller of Raynham,
that inmates have a constitutional right to all FDA-approved
addiction medications throughout their incarceration.
should be offered from the moment they are brought into the
system," said Sally Friedman, legal director of the New
York-based Legal Action Center, which is looking for a test case
to bring to court.
learned to be cautious about pharmaceutical company marketing,
said Andrew Kolodny, senior scientist at the Heller School for
Social Policy and Management at Brandeis University.
Not so for
criminal justice officials, who may be too trusting, Kolodny said.
drug company sends someone in to give them a talk and buy them
pizza, they think they're getting a scientific lecture," he
spokeswoman Jennifer Snyder said the company's sales team helps
educate corrections staff and community care providers only after
they have shown interest in Vivitrol.
widespread agreement that counseling, support groups and treatment
for underlying problems such as depression are crucial for
Vivitrol patients, said Dr. Joseph Garbely of Pennsylvania-based
Caron Treatment Centers, which supports medication-assisted
treatment and prefers Vivitrol.
of addiction is a cunning, baffling and powerful one,"
Garbely said. "And you need all hands on deck."