Will a 'miracle drug' reduce Arizona's prison recidivism?

Alexa Morgenroth’s long slide into opioid addiction began with a little pot smoking and alcohol as a teenager growing up in New York.

By the time she moved to Arizona in 2009, she was 26, had cycled in and out of recovery programs, but still found herself hooked on heroin.

It made her feel invincible. She couldn’t imagine a life without it.

She lied and stole to support her addiction. Two years ago, she was caught selling the drug, arrested and jailed. But her addiction didn’t stop inside those jail walls: She said opioids were readily available for the year and a half she was behind bars.

“It made me feel, at the time, whole,” said Morgenroth, now 33 and living in Scottsdale.

As she prepared to be released, her mom told her about another drug, one that would take away her cravings for opioids and give her a better shot at staying sober. Working with a local addiction and treatment center, Morgenroth got an injection of Vivitrol, six hours after walking out of the county jail. The medication blocks receptors in the brain and prevents the feeling of euphoria from opioids and alcohol.

“I didn’t think it would work because nothing else had,” she recalled. “But I have not had the desire to use drugs since I’ve been released. For me, being a chronic relapser, this was the only thing that works.”

Ducey's opioid-fighting proposal

Vivitrol is an injectable form of naltrexone, a drug that has been around for decades and comes in pill form to treat alcohol and opioid dependence. Vivitrol can last for 30 days and is emerging as a powerful tool for states, counties and cities to combat opioid dependency, health officials, addiction experts and state officials said.

Now, Gov. Doug Ducey is bringing the medication to Arizona prisons as a way to try to reduce recidivism and save public money.

In his State of the State address, the Republican governor announced he had signed an executive order that allows certain prisoners to be treated with the blocker before they leave prison “to maximize their success of never, ever going back.”

Of the state's estimated 42,300 prisoners, an estimated 2,500 have reported using opioids, according to the state Department of Corrections. The system's recidivism rate is about 40 percent.

The opioid-fighting proposal is the latest in a string of efforts Ducey has made to try to curb the growth of opioid abuse in Arizona, where drug overdoses outpace car crashes, falls and firearms as the leading cause of accidental death. State health officials cite Centers for Disease Control figures that show Arizona had 1,211 drug overdoses in 2014, the 15th highest in the nation. On average, according to the state Department of Health Services, one Arizonan dies every day from overdosing on prescription opioids.

Like other public officials, Ducey is grappling with the opioid epidemic. His actions include an order to limit initial painkiller prescriptions to seven days for Arizona adults insured by Medicaid or the state’s health-insurance plan, and is requiring all physicians in the state to complete continuing education in drug addiction.

Access to Vivitrol would begin through a pilot program involving about 200 prisoners, likely in Maricopa and Pima counties, and potentially in rural areas with health-care providers who can administer it, said Christina Corieri, a senior gubernatorial adviser.

Those who opt for the medication would be screened to ensure they’re healthy enough to receive it and have not had drugs in their system for seven to 10 days, and must agree to counseling once they are released, she said.

The drug can cost upwards of $1,000 a month.

Under Ducey’s proposal, prisoners would get the first injection before they leave the correction system. Corieri said state officials are talking with the manufacturer about covering the costs of the first injections.

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The program would help ensure prisoners are signed up for the state’s Medicaid plan, which will cover future injections. The state-provided insurance no longer needs pre-approval to be prescribed for Vivitrol.

“Recidivism has been an issue that the governor has been focused on … he’s also said he wants to make sure that when prisoners are released that their second chance is a true second chance,” Corieri said. “And we know that huge majorities of people that are in prison have had a past history of drug abuse. A lot of them will fall back into old habits when they leave, which inhibits their chance of truly being successful.”

Given interest in the drug in states like New Hampshire, Massachusetts and elsewhere, Corieri said she expects a high interest in Arizona, too.

'No medication can be successful alone'

Addiction experts said the medication could be risky for those who get the injection, and then use opioids. Since the receptors to feel the euphoria from the opioids would be blocked, those who relapse could accidentally overdose.

Matt Henson, a spokesman for Alkermes Inc., said the company's Vivitrol program has grown to include an estimated 375 criminal-justice programs in 36 states.

In some instances, public officials learn about the medication's successes from criminal-justice professionals. In others, state leaders learn about it from model-legislation groups, said Joshua Lee, an associate professor at New York University School of Medicine. Lee, who has studied the use of extended-release naltrexone and other treatments in inmates, and others, said the manufacturer markets heavily to public-safety officials.

Despite the drug's attention by federation officials to county sheriffs, Lee said more research is needed to determine the long-term effects on overdosing, relapsing and prison recidivism.

"We need more data ... and evaluation to see if this really works how we think it might, or if this is kind of a drop in the bucket and doesn’t help enough people, or if, in fact, it sort of worsens outcomes in ways we're not anticipating, but are still possible," Lee said.

Jeffrey Alvarez, a doctor and director of Maricopa County’s Correctional Health Services, said the prisoners are an ideal population for the drug because there is a high degree of relapses among opioid users when they leave custody.

But, he said, “No medication can be successful alone. It can’t work by itself. People have to have therapy and treatments. There has to be a hand-off to community providers to be successful.”

Alvarez said the county is also in discussions with the drug manufacturer about using Vivitrol in one of its substance-abuse programs for inmates.

Follow the reporter on Twitter and Facebook. Reach her at yvonne.wingett@arizonarepublic.com or 602-444-4712.