Judge Robert Peeler said he was “thinking outside the box” in August when a teen told him he was willing to do anything to beat his heroin addiction — a habit he was stealing to support.
“How far are you willing to go to stay clean?” Peeler asked the 18-year-old in Warren County courtroom.
Armed with research and a heavy heart after three defendants he released died from heroin overdoses, Peeler ordered the teen to undergo Vivitrol treatment.
The treatment is one of several ideas this newspaper has found court and law enforcement officials in the region are trying to stem the tide of rising overdose deaths from opiod-base drugs.
Peeler placed the juvenile on three-years community control and ordered him to complete an outpatient treatment and the Vivitrol program. He is on electronic monitoring, according to court records.
Treatment in lieu of conviction is available to an offender who previously has not been convicted of or pleaded guilty to a felony offense of violence, according to Ohio law. The option allows the person to complete drug treatment while on probation, and if successful, the charges would be dismissed.
The drug, approved for use by the U.S. food and Drug Administration in 2010, blocks receptors to the brain to prevent the person from feeling the effects of opiates, including heroin and morphine.
The concern for officials is who should pay for the drug. Health insurance and Medicaid pay for the pricey treatment, about $1,000 a dose.
In this case, the defendant indicated he had insurance coverage, which would mean the county would not foot the bill. But it is rare for those incarcerated to have private insurance, according to Warren County Sheriff Larry Sims.
Peeler and Sims said inmates lose their Medicaid benefits while incarcerated, so who pays for the treatment is in question.
Sims said since the order in August, meetings have taken place between Peeler, the county and those who treat inmates in the jail about the cost and the effect.
The sheriff estimated about 25 percent of the jail’s 180 inmates are addicted to heroin. He said he certainly appreciates Peelers’ outside of the box approach, but Sims said he also has to consider it from a business perspective.
Sims said pursuing grants to pay for the treatment is now part of the discussion and he has received no further orders to administer Vivitrol.
A small 2011 pilot Vivitrol program conducted in the Warren County Jail, “wasn’t very successful,” Sims said. The project resulted in only a 25 percent success rate.
“What we are doing is not working,” Peeler said. “This is a different option when other things haven’t worked.”
Warren County Commissioner and former Sheriff Tom Ariss said, “We had no idea it (Peeler’s order) was coming down.”
“There is a heck of a cost to it,” he added, noting he is willing to discuss options. “Where do we come up with the funding to do it? I am not sold on taxing the citizenry for addiction treatment.”
Butler County Sheriff Richard Jones said a 25 percent success rate is not enough.
“It is not our responsibility here in the jail to pay for your drug treatment,” Jones said.
Butler County judges said incarceration is not the answer to stopping heroin addiction and the crimes that come with it, but ordering a specific treatment remains an uncertain bet as well.
Montgomery County Juvenile Court Judge Anthony Capizzi said he probably would never sentence a child in drug court to take any drug that would alleviate the urgings to take an illegal drug.
“I understand that that approach has been taken around the country,” Capizzi said. “I personally don’t believe we should be prescribing an alternative drug to someone who has a drug problem.”
Capizzi said juvenile court is different than adult drug court, he doesn’t have specific knowledge about Vivitrol and that there are judges with differing opinions.
“There is a very strong treatment group that believes (prescribing drugs is) an appropriate treatment alternative,” he said. “I have not used it and I don’t believe in it.”
Montgomery County Common Pleas Court drug court supervisor Dave Taylor said no judge orders any defendant to ingest any specific substance. Judges can order treatment programs and those treatment agencies may or may not use Vivitrol.
Butler County Judge Noah Powers said it is something he would consider.
“I know is has gotten mixed reviews, but so has inpatient treatment. For some it works and for some it doesn’t,” Powers said.