'First shot is free': Hundreds incarcerated in Michigan offered opioid blocker shots

James David Dickson
The Detroit News

Detroit — Carl Brune told himself he could have kicked his opioid habit that he developed as a teen all on his own.

The 31-year-old Shelby Township resident spent six years “messing around trying to do it (his) way,” and would always backslide. Then he watched the drug kill his father in 2013.

From left, Carl Brune, 31, is photographed at Kyle's House, a 3/4 house, with current house manager Ryan Geml, 32, and Andrew Fortunato, 33, Brune's sponsor and manager of the house at the time Brune was there,  in Warren on Nov. 3.

That's when he received an injection of Vivitrol, a drug that fights the effects of opioids by attaching to the brain's receptors and preventing users from getting high.

"By the time I took Vivitrol, I was 30 days into sobriety," said Brune, who received the drug as part of his delayed sentencing in the city of Warren's drug court. "I wanted to give my mom peace of mind. For years, she had been dealing with my addiction and had just lost my dad to it."

It was a life-saving turn that, last year, hundreds of jail or prison inmates have tried as they prepare for life beyond bars.

The Michigan Department of Corrections says more than 20% of its inmates have an opioid-use disorder. Wayne County Jail, the state's largest, has similar numbers.

Inmates returning home after incarceration are at acute risk of overdose and death from opioids — between 40 and 120 times more likely to die of an opioid overdose, according to two studies cited by the Michigan Department of Corrections.

What makes opioid use so dangerous for newly released inmates is, surprisingly, the time they've spent away from the drug. 

If a person who's been locked up resumes his or her opioid use at the previous level, the risk of overdose is substantial, said Dr. Carmen McIntyre, chief medical officer of the Michigan Department of Corrections.

“Vivitrol is not the magic bullet," said Linda Davis, executive director of Macomb County-based Families Against Narcotics. "But what it does is it quiets the mind, so all the things you're telling the person can be absorbed. We're told so many times that people who are new to recovery, they can't quiet their mind, the cravings are so strong. Vivitrol helps."

Davis created Michigan's first drug court when she was on the bench in Clinton Township's 41-B District Court. 

The statistics bear out the need for intervention, which is coupled with behavioral therapy and peer support. The Department of Corrections says the medication-assisted treatment program, or MAT, is more than 40% effective in helping those who get the injections remain drug-free.

Last month, the Corrections Department announced it was expanding treatment. A pilot program last year provided 214 injections for inmates who were approaching their releases. Less than 1% of those who took the shot returned to prison, according to the Michigan Department of Corrections. That program cost $1 million.

This year, the department will spend $3.3 million expanding the pilot, said Holly Kramer, a spokeswoman for the Michigan Department of Corrections.

Grant funding from the New York-based Bloomberg Foundation will, for a "limited term," cover "at least one position, possibly two," but the term of the funding and the dollar amount have not yet been specified, she said. 

The expansion will bring the treatment to the Central Michigan and Carson City facilities, as well as the Charles E. Egeler Reception and Guidance Center, the entry point for all male prisoners in Michigan. While the women's prison will be the fourth expansion site, 86 women there already received Vivitrol injections last year.

'A thinking disease'

For Brune, using Vivitrol, which was free for the first shot, came with terms: attend 90 recovery meetings in 90 days, take the shot of Vivitrol, be drug-tested at least three times weekly, along with counseling. And stay in sober living for at least a year.

"A common misconception with someone who's using is that they have a drug and alcohol problem," Brune said. "That's not the case. We have a thinking disease. If you take away the drugs but don't fix the thinking, it'll be money, sex, or women you'll be addicted to next." 

Addiction started young for Brune. His first time drinking came when he was 12 or 13, when, he said, he consumed a fifth of vodka in 45 minutes. When Brune blew out his knee while playing hockey, he was prescribed opioids for the pain.

"I realized I didn't want to play hockey anymore," Brune said. "I wanted to get and stay high the rest of my life. The feeling of euphoria is the best feeling in the world. But it's never like it is the first time. Then you're chasing the dragon until your body develops a dependency on it."

Eventually, getting high wasn't about the benefits but about avoiding the so-called dope sickness that users feel during breaks, which Brune described as "the worst flu times 10,000."

Brune's sobriety began on Sept. 27, 2013. On Oct. 5, while he was living in a halfway house, Brune's father, also named Carl, died of an opioid overdose. Carl's obituary encouraged people to make donations to Families Against Narcotics.

What might have been a set back in Brune's recovery proved why recovery was necessary, he said. 

"I saw my future laid out, because he was only in his mid-50s, and I was 25 at the time," Brune said. "I knew I wasn't going to make it to 28."

A multi-pronged battle 

Michigan had 1,941 opioid-related deaths in 2017. More than 10,000 Michiganians have died of opioid overdoses over the last decade, according to the Michigan Department of Health and Human Services. 

McIntyre uses a football analogy to explain how the drug works for addicts.

"One team is trying to get the ball through the goal; that goal, in the brain, would be the opioid receptor," McIntyre said. "The competition tries to block you from getting to that goal."

Vivitrol is a high-priced monthly injection used to prevent relapse in opioid abusers. U.S. prisons are experimenting with the medication, which could help addicted inmates stay off heroin and other opioid drugs after they are released.

This blockage prevents opioid and alcohol users from feeling the effects of intoxication  for about four weeks after getting the shot. 

Inmates aren't just given the shot and sent on their way. That would be dangerous, experts say. The shot is offered only after therapy and alongside peer support. 

"Agreeing to Vivitrol happens after getting lots of education," McIntyre said. "It is not offered in the context of 'just get the shot, and don’t do any of the work on your own.' We work to make sure they have appointments set up in the community. We do two to three months of intensive therapy, education, motivational interviewing, and start talking to them about Vivitrol."

Last year, there were 17,792 admissions to medication-assisted treatment programs in Michigan, according to the Michigan Department of Health and Human Services. Roughly 20% of admissions involved the corrections system — inmates, people awaiting trial, people on parole or probation and people whose cases are in a diversion program that could lead to dropped charges.

In fiscal year 2019, the Department of Corrections introduced a MAT pilot program at seven facilities, including the state's only prison for women, at a cost of $1 million.

That does not include the costs of the medication, which according to the state budget, must be provided "at no cost to the department."

"The first shot is free," said Department of Corrections spokesman Chris Gautz, for those who are incarcerated. After inmates leave jail or prison, peer support workers try to connect them to Medicaid or private insurance, which would cover the shots for additional months. Without insurance coverage, an injection of Vivitrol would cost more than $1,300, according to Drugs.com, a drug information database. 

During the Department of Corrections pilot, 214 prison inmates — 128 men, 86 women — were given Vivitrol shots before release. Only 16 of them, six men and 10 women, went on to test positive for drugs and/or alcohol, and only two — one man, one woman — returned to prison after receiving the shot, putting the program's recidivism rate at about 1%. 

The follow-through numbers are less promising: only 12 men and 19 women, or about 14% of participants, continued receiving the shots for three months after being released. 

"This is a high-risk population ... Some won’t do well; the goal is to get as many to do better as possible," said Dr. Debra Pinals, medical director of behavioral health and forensic programs for the state Department of Health and Human Services. 

"You have to be really motivated to not pick up those bad habits again," McIntyre said. "And most people don't like receiving injections."

As for Brune, he's just proud that he beat back his addiction.

With steady work, and a wedding date set for March, he cares little about debating whether it was his own determination, or Vivitrol, that led him to end a fateful drug habit. 

"Did it hurt? Did it help?" Brune said. "Does it really make a difference? Because I'm here today."


@downi75 on Twitter.