ELLSWORTH — In recent years, county jails and state prisons have faced a growing problem: cells that are increasingly filled with inmates suffering from drug addiction and withdrawal.
Another problem? Once those inmates leave those cells, the odds are fairly good that they’ll wind up dead.
“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 Ryan Thornell, deputy commissioner at the Maine Department of Corrections (DOC), ticking them off.
“Likelihood of homelessness, trauma, some level of justice system involvement, poverty … Risk factors that elevate the chance of overdose are really prevalent.”
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.
Starting in July, the Maine Department of Corrections, along with addiction treatment company Groups Recover Together, began providing medication-assisted treatment 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.
“A large percentage of incarcerated individuals suffer from addiction, greater than 50 percent,” said Cooper Zelnick, CEO of Groups.
“Of those, 80 percent suffer from opiate use disorder,” Zelnick continued.
“There is a desperate need to not only connect folks with services upon release but I would argue treat addiction within correctional facilities so that folks have an honest shot at reentering communities.”
As of Aug. 1, fifty men and women were enrolled in the program, which has capacity for 115 prisoners, Thornell said.
The department received $500,000 in funding from the office of Substance Abuse and Mental Health Services to cover the cost of nursing staff and prescription services for the program, Thornell said.
The rest of the costs, such as for the prescriptions themselves, are covered by the state’s comprehensive contract with the Tennessee-based Wellpath corporation.
“We have a very concentrated population that we feel is at a very high risk and we have an opportunity to intervene and hopefully save lives at the end of the day and create a better community,” he continued.
A majority of inmates have been identified by the DOC as needing treatment for substance use, said Thornell, including 60 percent of men and 85 percent of women in Maine state prisons.
This program won’t come close to addressing the need, he added, but it’s a start, and administrators hope to eventually expand it into all DOC facilities if it’s successful.
The pilot program, which is modeled in part after a similar initiative in Rhode Island, started with inmates at the Maine Correctional Center in Windham, the Bolduc Correctional Facility in Warren and the Southern Maine Women’s Re-entry Center, also in Windham. To participate, an inmate must be within 90 days of release and meet certain medical criteria.
The state spent months studying how Rhode Island and other states have managed their medication-assisted treatment programs, said Thornell, looking particularly at how to prevent the medication from becoming contraband.
The best way to prevent that, he said, is to have a “strict regimented dosing process,” which means that inmates are observed while they take their medication and their hands and mouths are checked afterward to ensure the medication was consumed.
“The better we stick to that process the less issue we have with any type of diverting,” he said.
There’s another important aspect of the pilot program, and that’s what happens right after release, when inmates are most at risk of an overdose.
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.
To minimize that risk, administrators have partnered with Groups to connect former inmates with treatment services as soon as possible.
“We try to get them in within 24 to 48 hours of release so that they can see a counselor and so we lose the risk of them dying,” said Jocelyne Wood, regional manager for Groups.
The state isn’t the only one offering some form of medication-assisted treatment to inmates, Thornell said.
“A majority of the county jails are moving towards some level of having a medication-assisted treatment program or putting plans in place. There are four or five county jails with medication-assisted programs either running or nearing launch.”
That includes Hancock County.
“We have one, maybe two inmates currently receiving those services,” said Hancock County Sheriff Scott Kane.
“It’s something that’s coming down the line.”
“It seems to be the trend,” Kane said.
Although Hancock County has long offered counseling services and other drugs, such as Clonidine, to help manage withdrawal symptoms, medication-assisted treatment is another level, Kane said.
“Before,” he continued, “we didn’t allow any of those substances in jails. I didn’t want the issue of contraband introduced.”
Inmates are supervised while they take medication, said Kane, but he remains worried about diversion, which is why, he added, “I’ve stayed away from it for as long as I could.”
County administrators are putting together a budget that includes a full-time nurse on staff to help manage medications for inmates, said Kane, in anticipation of expanding the program.
There are a lot of unknowns for both county and state officials, Thornell said.
But the objective is the same.
“We want to save lives. I think that’s the ultimate goal of everybody involved.”