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A new weapon in Maryland’s fight against heroin

After almost 20 years dealing with convicts, Major Craig Rowe could see the trend.

“The majority of our crimes in Washington County are either directly related to or a byproduct of addiction, [whether] crime directly related to the heroin or the drugs or a crime they committed to obtain the drugs,” the warden of Washington County Detention Center said.

And while the facility offered substance abuse recovery programs, they were not effective in keeping county residents away from drugs. In 2010, less than 50 percent of individuals recovering from their opiate addictions in Washington County continued treatment upon release, Rowe said.

“People who are incarcerated, who have addiction, have an enormous level of relapse in the first 30 days after being released,” said Dr. Marc Fishman, an addiction psychiatrist and faculty member at Johns Hopkins University School of Medicine. “Just because you haven’t used for a month, a year, 10 years, 20 years — let’s say you’ve done 20 years in jail, that doesn’t mean you’ve gained recovery skills, that doesn’t mean you have sobriety skills to resist temptation, seek counseling.”

To counteract this, Washington County’s correctional facility partnered with the local health department and health provider Correct Care Solutions in 2010. Their goal was to create a medication-assisted treatment program that would help imprisoned opioid users begin recovery before they left the center and reduce the chance that they would return, Rowe said.

Under the program, imprisoned addicts were given an injection of Vivitrol, a drug that blocks opioid receptors in the brain, 10 days before their release as well as follow-up counseling and treatment. And Rowe saw a remarkable turnaround.

“Of individuals receiving this treatment, 92 percent continue treatment upon release. We’ve had less than 4 percent receive another charge since their treatment,” Rowe said.

Each monthly dose of Vivitrol costs about $1,100.

Recidivism rate

Normally, the county’s average offender-return rate is 23 to 24 percent, said Rowe, who was named the 2015 Correctional Administrator of the Year by the American Jail Association.

Four years after the first Vivitrol injection into a prisoner, Washington County’s successful re-entry program is being emulated by seven other counties whose officials hope to reduce the amount of opiate-related recidivism in Maryland’s jail system.

All told, 1,039 Maryland citizens died from drug overdose in 2014 — a 21 percent increase from 2013 and 60 percent increase since 2010, according to last year’s annual report by the state’s Department of Mental Health and Hygiene. The report found that 86 percent of those deaths involved opioids.

“We all know it’s a very serious problem, and it’s affecting many, many families in Maryland,” said Patty Mochel, communications manager of the state’s Office of Crime Control and Prevention.

Federally approved in October 2010, the monthly Vivitrol injection provides the only non-addictive treatment option for opioid users that also takes away the responsibility of swallowing a pill daily, said Jennifer Snyder, corporate communications senior director of Alkermes, the maker of Vivitrol.

‘Won’t get high’

Under Washington County’s program, former heroin and opioid users receive an injection of Vivitrol. If a drug abuser uses any opiate or heroin or if he drinks alcohol after receiving the treatment, Mochel said, he “won’t get any high off of it.”

“If [the opioid receptors in the brain] are all suitably blocked … then, if you try to use prescription opiates — oxycotin, percocet, heroin — it doesn’t work, so it renders the opiates ineffective,” Fishman said.

“Even at worse case, if they only get one dose and don’t connect with a clinic, at least during the most dangerous time they’ve been protected because it’s that first month that’s the most dangerous,” Fishman said. “Even one dose out of incarceration saves lives “

And knowing that they will not feel the same if they take opiates or heroin use after beginning the treatment keeps many former users from considering a return to drugs as it becomes too expensive a habit for weak results, Snyder said.

Gov. Larry Hogan’s administration announced Tuesday that eight counties including Washington collectively received $500,000 from the federal Byrne Justice Assistance Grants program to fund the expansion of drug treatment plans within their correctional facilities.

Other counties

Local health departments and correctional facilities in Anne Arundel, Carroll, Calvert, Cecil, Frederick, Howard and Montgomery counties will use their federal funds to develop medication-assisted treatment for inmates based on Washington County’s program, according to the governor’s office.

County inmates who are within three months of release and are opiate users qualify for the treatment. They will be enrolled in Medicaid or otherwise insured so they can continue to receive treatment after their release.

In Maryland, Vivitrol treatment is covered by Aetna, BlueCross BlueShield, CareFirst, Cigna, Coventry Health Care, Federal Employee Program, Kaiser Permanente and United Healthcare, Snyder said.

Washington County will use its monetary award to increase the size of its program and outreach, Rowe said.