Eligible inmates can receive the drug, which blocks cravings, shortly before release.

Nicole Welch couldn’t be at home with her 6-year-old daughter this past Christmas.

She also missed her daughter’s birthday.

Instead, Welch has spent nearly three months at the Erie County Prison, on charges she said stem from her heroin addiction.

It’s not the 29-year-old's first stay at the prison since she became addicted to opioids about 10 years ago. It’s her 14th, including for parole violations.

“It wasn’t who I was supposed to be,” she said. "I can’t do this anymore.”

A new program at the Erie County Prison is offering Welch and inmates like her an alternative — Vivitrol, an injection that curbs opioid cravings. Eligible inmates can now receive the drug shortly before their release date.

Prison officials said the first dose of the shot was provided to another inmate on Tuesday. Welch is eligible for the shot, but does not know when she will be released.

As opioid addiction continues to wrack Erie County, officials hope the voluntary program will help inmates who, but for their opioid addiction, might not be in prison.

"A lot of our population comes in addicted to substances," said Heidi Karash, RN, the director of nursing at the prison. "Crime and addiction are ... very closely related."

The prison is able to provide Vivitrol through a partnership with New Directions Healthcare, an Erie outpatient clinic that offers medication-assisted treatments such as methadone.

Welch, of Millcreek Township, said that her charges, including recent theft charges, resulted from her need to support her heroin addiction. She has been unable to make bond while she awaits prosecution in several cases, and has a plea hearing scheduled for Tuesday in one of them.

Being caught and sent to the prison turned out to be a blessing, she said.

"I’m glad I got caught, because I was 98 pounds when I came through these doors,” she said. She's at a healthier weight now.

Welch, who has overdosed numerous times — including once, in April 2013, on the same day she left the prison — knows the dangers of her addiction.

"There’s so many people that have passed away," she said. "It doesn’t really discriminate."

Through the prison's program, Welch has been referred to New Directions to receive the Vivitrol shot before her eventual release. She knows what she'll be getting into, since she has received the shot twice before, with temporary success, in other settings outside prison.

Welch stayed clean for several months each time she used Vivitrol, but eventually relapsed.

“I self-sabotaged,” she said. “I just wanted to use.”

She feels this time will be more successful because she is tired of the cycle of addiction and incarceration.

"I have a child, and my family can’t do it anymore," she said. "I can’t do it to my family. I can’t do it to myself."

For Anita Brewer, RN, the health services administrator at the prison, the choice to offer Vivitrol to opioid-addicted inmates is an easy one.

"If there's a drug out there that can help them and make them not want to do this, why not use it?" she said.

Vivitrol, which is the brand name for the drug naltrexone, prevents opioid cravings and blocks the effects of opioids in the brain. It is also used to help with alcoholism, but does not block other drugs, such as cocaine or methamphetamine.

The effects of each injection last for about 28 days before the dose must be renewed with another shot.

Eligible inmates at the Erie County Prison will be given their first Vivitrol injection a few days before their release, Karash said. The timing ensures they have almost a full month to follow up with New Directions before receiving their second shot.

“They walk out of there with an appointment to come and see us,” said Wendy McCullough, program director at New Directions.

McCullough also meets with inmates before deciding if they are eligible to receive Vivitrol. Inmates are referred to McCullough after completing a six-week drug-and-alcohol course at the prison.

“We’re looking for somebody who is motivated," McCullough said. "You need to convince me that you’re really serious about this medication.”

Karash said 17 inmates had been referred as potential Vivitrol recipients in the first few weeks the program was offered. Inmates must also meet medical requirements and receive an oral dose of the medication before they are prescribed Vivitrol, Karash said.

Once inmates who have received Vivitrol are released from the prison, they must follow through with treatment at New Directions, including counseling and group therapy.

McCullough said treatment that includes counseling, in addition to Vivitrol, is aimed at helping opioid abusers overcome their mental addiction and recognize when they are at risk for relapse.

Prison is a key time to reach opioid addicts and try to intervene, Brewer said. Because Vivitrol users must be opioid-free, inmates, who must undergo drug detoxification when they enter prison, are an ideal population for the injection.

"They've already gone through their withdrawal and their counseling, and by that point they're pretty levelheaded and they realize that they want help," Brewer said.

And leaving prison can be a dangerous time for inmates who begin using drugs again at the same level they did before their incarceration.

“Their tolerance decreases,” said Kara Bennett, the facilities director of New Directions and a nurse practitioner. “So what they used to use, if they try to go back and use that again, they’re going to die.”

The Vivitrol shot is expensive, but the first dose is being provided to the prison for free by the Ireland-based pharmaceutical company Alkermes. McCullough, the program director at New Directions, is also a paid speaker for Alkermes.

Each subsequent injection after an inmate's release can cost about $1,200, Bennett said. The shots can be covered by private insurance or state medical assistance, but can be cost-prohibitive for those without coverage.

There are also risks that come with using Vivitrol. A Vivitrol user who attempts to abuse opioids won’t experience a high without a substantial amount of the illicit drugs. That can easily lead to overdose, Bennett said.

“That’s part of patient education, and that’s the most important thing we discuss,” she said.

Despite the risks, and her rocky past attempts at using Vivitrol, Welch is eager to try the drug again.

"I just can't have my family get their hopes up and then see me fall, because I want them to know that they've stood by my side for something, not nothing," she said.

Madeleine O'Neill can be reached at 870-1728 or by email. Follow her on Twitter at twitter.com/ETNoneill.