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Ducey’s ‘Miracle Drug’ could be costly

Arizona inmates exiting prison with opioid addictions can be part of a substance abuse program that utilizes the drug Vivitrol, and while Gov. Doug Ducey calls it a “miracle drug,” some worry it is an expensive, understudied quick fix to a much larger problem.

Vivitrol is a monthly extended-release injection that prevents patients from getting high – as long as the patient is taking it consistently. Vivitrol works by blocking the receptors that opioids bind to in order to give the user any pain relief or euphoria.

“If they have the naltrexone in their system they will not be able to experience any euphoria from opioid,” said Daniel Ayanga, a psychiatrist who published a study on the treatment of opioid use disorder.

Once those patients are taken off the drug, they are just as likely to relapse as those who never had the treatment at all. And if the patient relapses while taking Vivitrol, they’re more likely to die of an overdose.

During the first month after their release, recovering addicts not on medication are 12 times more likely to die than the general public, with many of those deaths attributed to accidental overdoses. According to the Bureau of Justice Statistics, within five years of release, 77 percent of drug offenders return to jail. But among loyal Vivitrol users (including those who attend counseling), that number drops to only 9 percent.

That’s only while the patient is taking Vivitrol, though. Six months isn’t a cure; they must continue taking the drug, possibly indefinitely.

“Patients who take any form of opioid medication who discontinue it without adequate support systems tend to relapse,” said Ayanga. He added that those who are exiting prison are in a unique situation: they don’t usually have the right support systems and have economic troubles that often lead to dependence on opioid medications like Vivitrol.

Ducey’s order establishes a substance abuse program within the Department of Corrections and the Health Care Cost Containment System for inmates exiting prison, including treatment by Vivitrol and substance abuse counseling.

The program seems simple. A few days before their release, inmates receive their first shot of Vivitrol. After that, the patient must attend counseling and get their monthly shot of Vivitrol with the help of an assigned re-entry planner, who will be responsible for making sure the inmate attends counseling, gets their monthly shot and doesn’t relapse.

The success of Vivitrol is dependent upon these re-entry planners and the patient’s regular utilization of counseling. Over 60 percent of inmates drop out of treatment prematurely, according to the National Association of Drug Court Professionals, making Vivitrol considerably less effective. And, still, those who make it through that six-month treatment return to drug use afterward at the same rate as those who never had the treatment at all.

Christina Corieri, the health policy advisor for the state of Arizona, said they aren’t particularly concerned with that issue, and instead blames “arbitrary end dates,” like the six-month programs other states use.

Vivitrol is being used in over 100 programs across 30 states. Massachusetts has been using Vivitrol in its state prisons since 2015 and have 130 inmates in the program so far. Christopher Fallen from the Massachusetts Department of Corrections said they don’t know much about the success rate, “but we’ve got nothing but positive feedback.”

Like Massachusetts, Corieri said Arizona would give inmates Vivitrol for at least six months, as the FDA recommends. But unlike other states, she said the treatment could be indefinite.

Under the 2018 Budget, Ducey plans to fund $500,000 to the Department of Corrections. A total of  $400,000 will go toward funding an additional six substance abuse counselors and $100,000 will go towards re-entry planners.

The Vivitrol program will only cover “a couple hundred” inmates leaving custody, according to Corieri. Data from the Arizona Department of Corrections shows that there are approximately 42,000 prisoners in Arizona. Of these, 725 prisoners are enrolled in the addiction treatment programs, even though 75 percent of inmates assessed at intake have significant substance abuse histories. About 3.5 percent of Arizona inmates leave prison each month. So, around 25 inmates will be leaving prison each month who could be eligible for the substance abuse program; but it may be even more difficult than that to qualify.

“We’re going to start with a pilot program of a few hundred prisoners who both volunteer and are medically suitable for the program,” Corieri said. “They have to have a history of opioid abuse and a medical screen that shows that they [are] an appropriate candidate.”

Corieri said inmates must be “released to an area of the state where there are service providers for both the medication assisted treatment as well as the counseling,” which could remove any chance of rural opioid abusers to take advantage of the program.

Corieri also said AHCCCS will make the $1,000 monthly shot less expensive for inmates. If Access pays for half of the drug, the state will have to pay $500 per shot, per inmate. This means, in the most liberal use of these numbers, it will cost the state $3,000 per patient, if the patient only stays on Vivitrol for six months, not including the cost for substance abuse counselors. But the original budget proposal seems to lack any funding for the cost of the shot.

According to Corieri, individuals will not be responsible for paying for their own shots. It isn’t a specifically lined item in the budget because they expect AHCCS to cover most, if not all, of the cost of the treatment.

“I would compare [the cost of the new program] to the cost . . . to incarcerate someone,” Corieri said.

Let’s do that. It costs approximately $2,000 a month to keep a single inmate in prison. So, the state could be saving around $1,000 a month – for the first six months if that inmate was out of prison and using Vivitrol. Most drug offenders aren’t considering life sentences, but without an end date for the use of Vivitrol, the state could be paying for the drug indefinitely. And if patients fall back into opioid abuse after their treatment is over, it could be delaying the inevitable.

That isn’t making Ducey or Corieri any less enthusiastic about the program.

“We think if someone does need a year on the program or maybe even a little more to help keep them on the path back to the straight and arrow and have a successful second chance then that is something that we’re willing to invest in,” Corieri said.

Christianna Silva is the Don Bolles Fellow covering the Legislature for Arizona Sonora News, a service provided by the school of journalism at the University of Arizona. Reach her at christiannaj@email.arizona.edu.