While an extremely small sample size restricts the ability to draw broad conclusions from the results, a report from the San Diego Association of Governments suggests the need for more inquiry into the potential of the injectable medication Vivitrol for improving outcomes in criminal justice populations.
Nineteen opioid-dependent individuals who were enrolled in San Diego County's North County Drug Court and received at least one dose of the injectable form of naltrexone had fewer arrests and positive drug screens than a comparison group of 17 individuals not receiving the medication, according to a report released this summer. In perhaps the most striking finding, individuals who received a full regimen of at least six monthly injections experienced no relapses or recidivist criminal activity.
“We need to explain this—there is something here maybe,” says Sandy Keaton, a senior research analyst with the association.
Keaton says the findings, while not offering comparisons of statistical significance between the two groups studied, point to the need for further analysis. She adds that based on the results from the North County Drug Court pilot, San Diego County officials are exploring expanded use of Vivitrol across broader offender populations.
The North County Drug Court launched its Vivitrol pilot project in 2012. Nineteen opioid-dependent offenders agreed to enroll and received at least one injection. The two study groups had averaged around four arrests and one to two convictions in the 12 months preceding study enrollment. Fewer individuals in the non-medication comparison group reported opioids as their drug of choice.
Only 5 of the 19 individuals in the Vivitrol group received six or more injections during the study period, with four receiving only one injection; this points to concerns about client engagement. The report states that some individuals withdrew from the pilot for reasons such as having entered a residential treatment program or believing after some time that they no longer needed to take Vivitrol in order to stay clean.
Opioid cravings decreased in both study groups over time. Positive drug tests were considerably less frequent in the Vivitrol group (none in individuals who received at least six doses, 21% positives among those who received five or fewer doses, and 79% positives in the comparison group).
Similar results were seen with arrests. While no individuals receiving six or more doses of Vivitrol had been rearrested 18 months after study entry, 30% of those receiving fewer doses and not in custody had been rearrested and 6% of the comparison group had been rearrested at the 18-month mark.
Vivitrol is intended for use with psychosocial support, and the extent of additional services that these offenders received is not known through this analysis. That is another significant limitation of these findings.
Individuals representing the justice and treatment systems serving these offenders completed a survey of their opinions about the pilot; many said the program should be expanded and that participants should receive their first Vivitrol injection prior to release from custody. Comments from survey respondents included, “This has contributed to the success of clients that had otherwise not been able to stay clean,” and “Clients who have access to caring and supportive staff in the context of close and consistent supervision will do better with this drug.”
Implementation challenges that remain include improving retention in treatment and overcoming Vivitrol's significant cost (approaching $1,000 per monthly injection).
Acknowledging the limitations of this report's findings, Keaton nevertheless says, “This does point to the need for further examination with a larger sample.”