“A Shot at Life” Pilot Program Reduces Recidivism and Relapse Rates

When District Attorney General Charme Allen took office in 2014, overdose deaths were skyrocketing in Knox County, jails were overcrowded and there were limited options for people with opioid use disorders. These pressing issues warranted a swift and multi-pronged approach. While also launching the Overdose Drug Task Force with law enforcement partners to target dangerous drug traffickers and the supply of drugs in our community, the District Attorney’s Office researched ways to reduce the demand for drugs in our community. Knox County’s criminal justice system needed an effective jail diversion program that provided intensive treatment and supervision that was focused on recovery.  The District Attorney General’s Office, specifically, wanted to research and study potential solutions that blended treatment and criminal justice accountability.

In 2017, the District Attorney General’s Office, Helen Ross McNabb Center, and Knox County Sheriff’s Office started a pilot program referred to as “A Shot at Life.” The pilot program embedded medication assisted treatment into the Knox County criminal justice system to reduce recidivism and relapse rates for non-violent offenders with opioid use disorders. This type of treatment combines behavioral therapy and medications to treat substance use disorders. The “A Shot at Life” program specifically used Vivitrol, a brand of naltrexone. Vivitrol is used to prevent relapse to opioid dependence, after opioid detoxification. The medication binds and blocks opioid receptors and is reported to reduce opioid cravings. The overall goal of the pilot program was to demonstrate the community benefit and cost savings of providing appropriate levels of substance abuse treatment in lieu of incarceration for non-violent offenders.

The pilot program was funded by a grant from the Trinity Health Foundation of East Tennessee and the medication used was donated by Alkermes, the pharmaceutical company who manufactures Vivitrol. The program was designed to identify 30 offenders to participate in the program for the course of 18 months. To qualify for the program, a candidate needed to be a non-violent offender with no prior convictions for a violent crime, a Knox County resident, and have an opioid use disorder diagnosis. It was also important for the candidate to have an approved plan for housing and secured community support. The Knox County Sheriff’s Office and the District Attorney General’s Office identified inmates who qualified for the program. Then clinicians from Helen Ross McNabb Center provided a thorough clinical assessment to ensure that the individuals selected were appropriate for the program.

Once a candidate was accepted into the program, he/she received the first injection while in jail.  Subsequently, he/she would be released from jail and transported directly to the first treatment session at the Helen Ross McNabb Center which provided outpatient treatment and random drug screens. Once the participant completed the 12-month regimen, the Helen Ross McNabb Center provided an additional six months of aftercare.  Weekly progress updates were submitted to the DA’s office. If any participants, did not abide by the terms of the program, they were reported to the DA’s Office.

As a result of the program, recidivism was drastically reduced. The numbers below show a decrease in the number of charges accrued before and during treatment by the 30 individuals who participated in the program.

341:        Charges accrued during the five-year period preceding treatment

72:          Charges accrued in the year preceding treatment

20:         Charges accrued during treatment

To effectively reduce recidivism rates, relapse rates must also be reduced. The “A Shot at Life” program experienced a reduction in relapse rates.  As an example, 87% of “A Shot at Life” participants had a very high Adverse Childhood Experience scores at intake, which put them at high risk for relapse and recidivism. Each participant who received treatment for 6 months or more had a reduction in depression and/or anxiety, which lead to 67% of participants achieving sobriety and maintaining recovery at the 6-month mark. Additionally, 73% of participants gained employment, which is a positive indication of their emotional well-being, as well as their ability to support themselves and their dependents.

Nationally, relapse rates for drug addiction are reported to be between 40-60%. However, opioid relapse rates tend to be higher than the 40-60% relapse rates associated with other substance use disorders. Reaching a 67% rate for achieving sobriety and maintaining recovery at the 6-month mark speaks to the effectiveness of medication assisted treatment.

At the conclusion of the pilot program in 2019, the Knox County District Attorney General’s Office concluded that medication assisted treatment is helpful in reducing recidivism and relapse rates. This inevitably protected Knox County citizens from crime, saved taxpayer dollars and helped save lives. The “A Shot at Life” pilot program is being used as a model to make Vivitrol and other medication assisted treatment medications more readily available for individuals living with an opioid use disorder.

Today, individuals who interact with the criminal justice system can qualify for Drug Court and receive medication assisted treatment or can directly access care through providers like the Helen Ross McNabb Center. Other medication assisted treatment is available thru the Tennessee Department of Mental Health and Substance Abuse’s HUB and SPOKE SOR Program. Many insurance plans, including TennCare, cover medication assisted treatment as a level of care.

District Attorney General Charme Allen supports medication assisted treatment options for non-violent offenders who willingly and actively participate in treatment. The pilot program demonstrated positive results while individuals were engaged in the program. However, the program also demonstrated that individuals need long-term care and supportive relationships to maintain sobriety. These findings reveal a need for additional community support for individuals in recovery. Therefore, the District Attorney General’s Office invites the community to join the fight. There are multiple ways to get involved. To learn more, visit https://www.all4knox.org/.

If you or someone you know is struggling with substance misuse and/or addiction, call the Tennessee Redline today for free, confidential information and referrals: 1-800-889-9789.