Judge tries medical treatmentagainst heroin-related crime (En)
The 18-year-old stood in front of the judge in a Warren County courtroom in August accused of stealing $169 from patrons at the Kings Island water park.
With a long list of petty crimes already behind him at such a young age, the teen, a heroin addict, this time had racked up his first felony. He was facing up to three years in prison. He had already been in jail for 10 weeks. He told the judge he wanted to beat his drug habit and was willing to go into inpatient treatment.
Judge Robert Peeler had another idea. He already had three defendants die of heroin overdoses after he released them from jail early.
“They died because I released them. It’s impossible to keep them all in jail,” he said.
So, in a first for local criminal justice systems and a move that’s being studied at several prisons and jails across the country, Peeler ordered the defendant to undergo a series of nine to 12 injections of Vivitrol, the non-narcotic drug naltrexone that blocks the brain’s ability to get high on opiates, including heroin, or drunk on alcohol. He ordered the teen to receive the first shot while in jail.
The drug, which the Federal Drug Administration approved in injectable form in 2010, helps addicts to keep from relapsing. The risk of relapse among individuals with opioid addiction is extremely high – up to 90 percent over the course of a year without what is called medication assisted therapy, research shows.
Peeler’s order raised eyebrows at the Warren County Jail. No other local counties do this, and one other Greater Cincinnati sheriff called it “a waste of money.”
It “came out of the blue,” Warren County Sheriff Larry Sims said.
Generally, distributing medication for addiction is not a common practice in jails, according to the federal National Institute on Drug Abuse. Orman Hall, director of the Ohio Governor’s Opiate Action Team, said he doesn’t know of any other jails in Ohio that offer inmates medication to prevent relapse outside of a study or pilot project. Now it’s become a topic of study and discussion in Warren County that could open the door for more addicted inmates to receive the treatment, a portion of it at taxpayer cost because the vast majority of prisoners don’t have private insurance.
“There’s not a lot of rehab in jail that I’m aware of,” Peeler said. “I just think that’s the best place to start.”
Big question: Who will pay for this?
The monumental task is figuring out how to pay for the costly injections for inmates who want the treatment but don’t have insurance. Vivitrol retails for about $1,000 a shot. The teen had private insurance that would pay for the series of injections.
Sims also is concerned about how the treatment will affect his already overcrowded jail. Will it mean longer stays for inmates waiting to receive the first injection while they are incarcerated?
Experts say it’s best to give the first injection in jail. That buys the inmate a month to get Medicaid benefits to pay for the next shots and to set up drug counseling on the outside. Receiving the injections with counseling makes the treatment more successful, experts say.
Medicaid won’t pay for the first shot because inmates lose those benefits while they are incarcerated. A county is responsible for the cost of inmates’ health care while they are in jail.
It cost Warren County taxpayers $7.5 million to run the jail in 2013. Sims estimates that about 20 percent of Warren County’s inmates are heroin users.
Hall says giving the injections in jail also is about saving lives. People addicted to opiates lose their tolerance for the drug rapidly, but they don’t lose the craving. Once released from jail, they tend to use as much heroin as they did before they were arrested, overdose and die, he said.
‘It’s a waste of money’ at 25 percent success rate
Statistics from the Ohio Department of Mental Health and Addiction Services show that 36 percent of people treated with naltrexone stayed opiate-free, compared to 20 percent to 50 percent who used the replacement narcotic suboxone and 60 percent for methadone. A 2011 pilot program that provided Warren County inmates with Vivitrol injections had a 25 percent success rate.
Some experts have criticized the use of suboxone and methadone, though, as merely replacing one narcotic for another and getting the patient addicted to a similar drug.
At least one local sheriff said drug treatment of opiate addicts won’t happen in his jail. It’s too expensive and doesn’t have a high enough success rate. Jails in Clermont and Hamilton counties also don’t dole out medication for drug addiction treatment.
“It’s a waste of money at 25 percent. That means you are a 75 percent failure,” Butler County Sheriff Richard K. Jones said of the results of Warren County’s pilot program that ended last year. “We stopped all drug rehab programs and drug classes, alcohol classes five years ago. We have no money for anything like that.