Inside the Knox County Jail, a drug called Vivitrol is marketed to inmates as a shot to turn their life around.
It has been more than two years since the jail started an experimental program to give a handful of inmates shots to help them use time behind bars to beat drug addiction. So far 30 inmates have been given the Vivitrol shots with mixed results.
RELATED (2/27/17): Vivitrol treatment program starts in Knox County
“Is it a complete success? No,” said Knox County District Attorney Charme Allen. “Is it a great step in the right direction? You could argue yes.”
While experts agree the shots help those battling addiction, questions remain about whether they are the most cost-effective treatment option and whether the drug works without also going to counseling sessions.
Vivitrol blocks the receptors in your brain so that you can’t get high for nearly a month after getting the shot. Inmates participating in Knox County’s ‘Shot at Life’ program are given their first dose while inside the jail. They are then released and go through counseling sessions with Helen Ross McNabb. It takes a year and a half to complete the program, getting one shot every month.
“67% are still in recovery, not using, six months after the program,” said Allen. “73% of the individuals that we’ve run through have become gainfully employed. I think you can look at employment rate and that alone is a step in the right direction.”
The 30 inmates who were chosen had accrued 72 charges the year before beginning the treatment. Since then, only four have been arrested again, picking up 20 charges total. Most of the new charges are drug-related.
“It’s like anything. Some people are very successful in this program, some people are not,” said Allen. “We are trying to get these people who are addicted to be in recovery, stay in recovery. As long as they are in recovery, we think that the recidivism numbers will be extremely low.”
Former Sheriff JJ Jones started the program and it will be up to Sheriff Tom Spangler to decide whether to continue.
“It’s not that I’m skeptical, it’s just that we are still looking for numbers to see what it’s going to do,” said Spangler. “You’re looking at about $1,000 plus for each shot. So if you’re looking at 30 shots, there’s $30,000 right there already… when you go and ask people to start paying for that, that’s a lot of money.”
The program was funded by a grant which paid for the counseling sessions. The drug company provided 360 shots to the jail for free. But Vivitrol is costing the government, and taxpayers, millions of dollars in Tennessee.
In 2013, Tenncare paid for less than a million dollars’ worth of the drug. By 2016, the number had surpassed $12 million. Across the country, fueled in part by inmates signed up to Medicaid, Medicaid spending on Vivitrol jumped to more than $200 million in 2017. That’s up 2,500% since 2013.
Other addiction treatment drugs like buprenorphine, also known as Suboxone, are said to have similar relapse rates but are far cheaper. Here in Knox County, leaders attribute the programs’ success to the therapy sessions used in conjunction with the drug.
“Medication alone has proven to be not nearly as successful,” said Jerry Vagnier, President and CEO of the Helen Ross McNabb Center. “Every month they come for one shot. In addition to that, they come to intensive outpatient treatment three to four times a week, they meet with other people in recovery and a professional counselor to work on their skills and on their recovery.”
Success and failure
We first met Gregory Fox inside the Knox County Detention Facility when the Sheriff’s Office administered his first shot of Vivitrol in February of 2017. He was the first inmate in Knox County to get the drug behind bars.
“I couldn't tell you the last time I've actually been high," Fox said at the time. "I just do it to function basically. I basically just take pills to be able to work."
Soon after he was given his first shot, he was released and went into treatment with Helen Ross McNabb while also continuing to get Vivitrol shots.
In January of 2018, we met Fox outside of jail. He had a job and a family and seemed to be on the right track to recovery.
“I’ve got my kids, I’m back working for myself. I’ve not had issues with the police or worry about finding drugs every day,” Fox said. “They gave me a shot and they thought I could do it. I did it, I graduated the program, I could never thank them enough for it.”
Months later he was back in jail. He was arrested for violating probation and then picked up additional charges for sneaking drugs into jail.
“He’s an example, like many of our participants in our program, that do well for a while and then they backslide,” said District Attorney General Charme Allen. “What are you going to do the first time they backslide? That’s something that we’ve had to do with every single one of the 30 participants in this program time and time again.”
But there are other Vivitrol users who say the drug has helped turn their life around when nothing else could.
“I couldn’t stop using, so I needed to reach out for help,” said Whit Maddox, a Vivitrol user who started getting the shots after he was released from jail. “I’ve tried to get clean multiple times throughout this. That’s something that’s always been there for me and I’ve always struggled with a lot.”
Maddox is not a part of Knox County’s ‘Shot at Life’ program. He has been in and out of jail for much of his life and came to Helen Ross McNabb to begin the treatment program.
“It’s a shot that I get once a month. I find that when I get the shot, I don’t have cravings, I don’t have thoughts of using or dreams about using,” said Maddox. “Prior to treatment and prior to the shot, a thought would come about using and it would just not go away. Now I feel like when I get those thoughts they go away almost immediately and it’s very rare that they come.”
Maddox credits much of the program’s success to the counseling sessions he goes to in addition to getting the shots. They are designed to teach recovering addicts how to function in society while staying clean.
“This is far more than just a shot. This is about employment, this is about taking care of your debt to society, paying your fines and fees, and reconnecting with family and friends,” said Vagnier. “Medication alone has a bad outcome. Medication with talk therapy and social support has a very good outcome opportunity.”
A medical perspective
Dr. Edward Capparelli has given dozens of people Vivitrol. He's a doctor at Mountain People's Health Councils in Oneida, the Chairman of TennCare Pharmacy Advisory Committee and the Speaker of the House of the Tennessee Medical Association.
"Vivitrol is a true antagonist, which means it blocks the receptors and they can’t respond to the opioids," said Capparelli. "As far as preventing the opioid receptors from being activated and preventing people from getting a buzz from the opioids, it works tremendously well."
Capparelli says the drug works best when coupled with other treatment options like counseling and therapy. For a lot of addicts, help is needed to teach them how to live a normal, sober life.
"People who have abused opioids have a need to receive other services such as counseling, case management where we work with them with life skills," said Capparelli. "They have to learn how to live all over again after they’ve spent time with addiction. Vivitrol helps with the cravings, but it has to be part of an overall treatment plan, not just be used by itself."
Learning from mistakes
The Knox County Vivitrol program began in 2017, but leaders took a trip to Massachusetts years before to learn from the Barnstable County Sheriff’s Office.
“We started the program back in 2012. So far we’ve treated a little over 300 former inmates,” said Barnstable County Sheriff James Cummings. “The way the program works is that a week or so before somebody is going to get released from custody, we give them their first injection.”
The Barnstable County Jail was one of the first in the country to begin giving Vivitrol to inmates behind bars. The Knox County program is based on the one in Massachusetts. Still, there was a lot to learn.
“It’s worth noting that this was a pilot program. When we started it, we did not have all the answers,” said Allen. “In the beginning we let people stop taking the shots prior to the entire 18 months. If they were doing well in group, we let them stop the treatment piece with Helen Ross McNabb and we let them stop the Vivitrol shots. We have learned through trial and error that we think it’s much better to do an entire 18-month protocol on everybody.”
Two years in, there are questions about what the future of the program in Knox County may look like. The grant that originally funded the program has run out. It is unclear when or if more money will come for another round of inmates to get treatment.
“It’s just the unknown. What is it going to do long term? What will it do for us? What will it do for the individuals that are on that program? That’s what we want to know, is it being successful?” said Sheriff Spangler. “I’m responsible to the people who put me in office to be responsible for their tax dollars. We have to make sure that we do that in a responsible way and that’s what we will do.”