ELLSWORTH — The Hancock County Jail will soon join Washington County and several state prison systems in offering medication-assisted treatment to inmates struggling with addiction.
“We’re working to get that up and running here,” said Hancock County Sheriff Scott Kane. “Just waiting for a couple of changes to a contract with the state. I have permission from the commissioners to sign that and then we will advertise for a nurse to come in and administer the medication.”
The Washington County Jail has been offering medication-assisted treatment to inmates for several months, said Jail Administrator Rich Rolfe.
“Right now it’s done in our medical room,” Rolfe said. “It’s very well controlled; [the nurse] is required to inspect the mouth before and after. There’s a whole protocol set up.”
While some medications can be delivered via a medical cart to each cell block, said Rolfe, Suboxone distribution must be tightly managed to prevent the drug from being diverted.
Maine has 15 jail and adult detention facilities, with a population of 1,750 inmates, according to the National Institute of Corrections, and another 2,279 inmates in its six adult prison facilities.
A majority of inmates have been identified by the Department of Corrections as needing treatment for substance use, said Ryan Thornell, deputy commissioner at the Maine Department of Corrections, including 60 percent of men and 85 percent of women in Maine state prisons.
Jails have long offered addiction treatment for inmates, including counseling and non-opioid medications to help with withdrawal symptoms.
But some states and counties are increasingly turning to opioid-replacement drugs, including Suboxone, to help inmates deal with cravings and put them on a path toward recovery.
The Maine Department of Corrections began providing medication-assisted treatment this summer in three state prisons as part of a year-long pilot program that administrators hope to bring to the Legislature next year and hold up as a model for the future.
“If you look at the risk factors associated with overdose deaths related to opioid use, the clients in prison fit the bill for most of those high risk factors,” said Thornell in a previous interview.
“Likelihood of homelessness, trauma, some level of justice system involvement, poverty … Risk factors that elevate the chance of overdose are really prevalent.”
That treatment may save lives. A recent study in the New England Journal of Medicine found that in the first two weeks after being released from prison, former inmates are 129 times more likely than the general population to die of an overdose and 12 times more likely to die, period.
Although Hancock County has long offered counseling services and other drugs, such as Clonidine, to help manage withdrawal symptoms, medication-assisted treatment with opioid-replacement drugs is something Kane said he’s avoided for “as long as I could,” because he was wary of introducing a substance heavily sought after as contraband into the jail.
And not providing such medication could potentially violate federal law. In March, U.S. District Judge Nancy Torreson ruled that the Aroostook County Jail must provide an opiate treatment drug to a Madawaska woman while she serves her 40-day jail sentence there, a ruling upheld by a federal appeals court in Boston this spring.
After a weeklong trial in Portland in February, Torresen ruled that denying the woman her medication in jail would “cause serious and irreparable harm” and would violate the Americans With Disabilities Act.
Torresen wrote that a “body of evidence has emerged that permitting MAT in correctional facilities offers substantial, and possibly essential, benefits to incarcerated people. One study of English correctional facilities found that treatment with buprenorphine (Suboxone) or methadone was associated with an 80 to 85 percent reduction in post-release drug-related mortality.”
In the several months it’s been up and running, the Washington County program has had, at the most, “three people at a time that are on Suboxone,” said Rolfe. “Anybody that comes in with Suboxone we continue their treatment.”
Rolfe said the program is new, but “I think it’s gonna be successful. We may have to tweak things a little bit. We’ll go Plan A and if we need to shift it and change things a little bit we will. I don’t anticipate any major changes, but certainly it’s a little too early to tell.”
As for Hancock County, Kane said he anticipates roughly five or six inmates might be eligible to receive medication-assisted treatment once the program is set up, but it’s too soon to really tell.
Both jails are receiving state funding for the program via grants managed by nonprofit organizations such as Healthy Acadia and Aroostook Mental Health Center. They are also working with local providers to connect inmates with counseling and treatment once they’re released.
But programs that are funded solely via state grants make him nervous, said Kane.
“I’m always leery of where the funding for these programs comes from,” he said.
A change in administration or policy could put funding at risk, resulting in the burden to keep the program going falling on the county.
Kane said he expects to receive roughly $60,000 or $70,000 in state money to fund the program for six months beginning in January.
“Anything new, you’ve got to do it right the first time. If you don’t, people are going to be against it. We’re walking very, very slowly.”