If successful, an effort to secure a federal grant to bring medication-assisted treatment to all of Maine’s 15 jails would accelerate a process that already is underway in some parts of the state.

George Shaler, a senior research associate at the Muskie School of Public Service at the University of Southern Maine, said the Muskie School, Massachusetts General Hospital and others have joined forces to pursue a federal grant, part of which would, if successful, bring funding for medication-assisted treatment – considered the “gold standard” to help those with substance use disorder – to Maine’s jails.

Medication-assisted treatment involves combining counseling and other behavioral therapies with medications such as Suboxone and methadone to curb patients’ craving for opioids.

Shaler said he couldn’t be specific at this time about the grant, because releasing more information could jeopardize the chances of securing the grant in the competition with others for funding. He said they will know in about two months whether they won a grant award, which would open up treatment access to Maine’s jail population of 1,700 inmates.

“We want to help the jails as much as possible provide this treatment,” Shaler said.

WEALTH OF DATA ABOUT EFFICACY

Meanwhile, a pilot program to bring medication-assisted treatment to York County is in the works, and likely will start in January. The longest-running such jail program in Maine – in use in Penobscot County for the past two years – involves the medication Vivitrol. Other jails also are independently considering or have started medication-assisted treatment programs, including in Androscoggin, Waldo, Cumberland, Penobscot, Aroostook and Kennebec counties.

Maine’s opioid crisis is causing drug overdose deaths to soar – there were 418 in 2017 and 180 through the first half of 2018. Research shows a vulnerable moment for people suffering from substance use disorder is when they are released from jail without having received treatment.

People who have built up a tolerance to opioids tend to use more when they are suffering from substance use disorder. When they are forced to abstain – such as by being in jail – and then relapse, they often use the same amount of opioids as when they had built up a tolerance to the drugs, resulting in an overdose.

According to research published in April in JAMA Psychiatry, Rhode Island experienced a 61 percent decline in fatal overdoses among prisoners released in the six months after medication-assisted treatment became available in its prisons, compared with before the state started the program. About two-thirds of all incarcerated people have some form of substance use disorder, research shows.

Mary-Anne LaMarre, executive director of the Maine Sheriffs Association, said the issue is a priority in Maine, and “there is a wealth of information that points to the efficacy of (medication-assisted treatment) as it pertains to recidivism reduction.”

If medication-assisted treatment is expanded to all of the state’s jails, Maine would be on the leading edge of offering the treatment to its inmate population.

A spokesman for Gov.-elect Janet Mills praised the efforts to expand access to medication-assisted treatment and said Mills would build upon them after she takes office Jan. 2.

“Governor-elect Mills is a strong advocate for expanding access to medication assisted treatment because it has proven to be an effective method for treating opioid use disorder,” Scott Ogden said in an email. “She applauds the efforts of the Maine Sheriffs Association and hopes to expand on them as governor so that those who need treatment are able to receive it and begin down the path of recovery.”

‘THE PATHWAY TO RECOVERY’

Nationally, the treatment is still not typically offered in most jails, but there’s momentum to do so, and the correctional system may be near a tipping point, said Dr. Kevin Fiscella. A Suboxone treatment provider in Rochester, New York, Fiscella serves on the National Commission on Correctional Healthcare. He said there aren’t reliable estimates yet on how many jails or prisons now offer medication-assisted treatment, but there are notable efforts in Rhode Island, Vermont, New Jersey and other locations to have the treatment available.

“We may have hit a critical period,” Fiscella said. “There is an emerging consensus that there should be treatment in jails for substance use disorder that should be similar to the treatment that is provided in the community.”

Tim Cheney, principal at ENSO Recovery, which will be providing medication-assisted treatment in the York County Jail, said getting the treatment into jails has the potential to help a lot of people and lower overdose rates. He said incorrect perceptions that medication-assisted treatment is merely replacing one drug with another are going by the wayside, and he’s seeing more acceptance of bringing the treatment into the jails. He said concerns about diverting Suboxone from jails to be sold on the streets can be addressed by building controls into the system that make diversion extremely unlikely.

“Detoxification is not real treatment,” Cheney said. “MAT is now the standard. This is the pathway to recovery.”

Joe Lawlor can be contacted at 791-6376 or at:

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