Credit: Troy R. Bennett

About 60 percent to 85 percent of inmates in Maine prisons struggle with some kind of addiction, whether it be alcohol or opioid.

Despite those statistics, inmates in Maine Department of Corrections custody have not been able to receive medication-assisted treatment, which research shows is a more effective way to treat opioid addiction than counseling alone.

Next month, that will start to change.

Through a partnership with the substance use treatment organization, Groups: Recover Together, about 100 to 150 inmates will have the opportunity to receive medication-assisted treatment, paired with counseling and other services, prior to their release.

State corrections officials and addiction experts hope that this pilot program will not only help individuals overcome their addiction, but also make for a smoother transition into the community upon release.

“The rates of addiction and overdose are so high, and it’s such a significant issue in Maine, that it would really be irresponsible of us not to take advantage of the environment that we have [in correctional facilities] to at least start [inmates] on treatment,” Deputy Maine Corrections Commissioner Ryan Thornell said. “It’s just the responsible thing to do.”

During the past three months, state officials have worked to identify inmates at three correctional facilities who are within six months of release and have faced opioid addiction. This month, Thornell said staff will conduct medical meetings with the inmates they have identified as potential participants in the program to determine if they are willing to take part in the pilot.

On July 1, when the selected participants are about 90 days from release, they will begin to receive the medication-assisted treatment. Thornell said the number of inmates who receive treatment will depend on how many agree to participate, but they hope to include about 100 to 150 inmates in the pilot program.

Upon release, participants will receive treatment referrals from Groups to continue working on their addiction within their own community. This transition of care from inside a state correctional facility to the community is what Groups Executive Director Cooper Zelnick said will set Maine apart from other states working to make medication-assisted treatment available to inmates.

“I think this is an incredible step forward for Maine. It’s much needed and [medication-assisted treatment] is the gold standard,” Zelnick said. “It will set a standard that many other states need to follow.”

The best way to treat opioid addiction

Medication-assisted treatment is the use of medication, such as methadone and suboxone, in combination with counseling or therapy to treat opioid addiction.

As Maine, along with the rest of the country, grapples with how to address the opioid epidemic, medication-assisted treatment has become a standard practice in treating opioid addiction.

“It’s the gold standard of treatment. Not just in corrections, but in general,” Thornell said.

Opioid addiction is notoriously difficult to beat largely because there is a physical dependence that accompanies all of the psychological issues that come with addiction, Zelnick said. The medication helps to diminish the physical side effects that come with detoxing from opioids.

“If you can’t control the physical dependence or craving, it’s really difficult to deliver the therapy that allows people to truly change their behavior and change their lives,” Zelnick said. “By allowing folks to be free from withdrawal and cravings, individuals are given the opportunity to engage in their therapy and make those changes.”

Groups has a widespread presence in Maine, with offices in nine communities including Biddeford, Portland, Lewiston, Farmington, Augusta, Rockland, Calais and Machias. Groups is also preparing to open offices in Belfast, Bangor, Waterville, Houlton and Rumford.

Across the state, Groups treats about 1,500 Mainers struggling with addictions every week, Zelnick said, through a combination of medication-assisted treatment and group therapy.

With this model of addiction treatment, Groups is seeing six-month retention rates of 71 percent for privately insured clients and 87 percent of MaineCare clients.

“People are not only staying in treatment, they’re engaging with their treatment and succeeding because of treatment,” Zelnick said.

Getting into prisons

In Maine, the number of inmates entering correctional facilities due to drug-related offenses has increased nearly every year since 2014, according to DOC data.

Upon entry into a DOC facility, Thornell said, inmates go through an assessment of needs, including substance use treatment. About 60 percent of male inmates in Maine prisons have been identified as needing treatment for substance use. For women, this rate jumps to 85 percent, Thornell said.

Once the need is identified, the inmates are put on waiting lists for either residential or outpatient treatment, typically centered around counseling. At any given time, more than 100 inmates across the DOC system are receiving treatment, Thornell said.

“I will tell you right now, we do not have the treatment and programming resources that are necessary to address 60 percent to 85 percent of our population needing substance use treatment,” Thornell said.

With tight budgets and a fear of medication-assisted treatment programs being used to traffic drugs, getting medication-assisted treatment into prisons has been slow to start. That trend is now starting to change.

Last month, a federal judge upheld a lower court decision that the Aroostook County Jail in Houlton must allow a Madawaska woman to continue taking her medication-assisted treatment while she is incarcerated.

Corrections departments in states such as Rhode Island, Vermont, Connecticut, New Hampshire and Kentucky all have some form of a medication-assisted treatment program in place, Thornell said.

Establishing a medication-assisted treatment pilot program for Maine prisons was one of the first goals Corrections Commissioner Randall Liberty set for the department when he assumed office earlier this year.

“We are a department in an administration that is committed to doing what makes sense and what is right, even it that means breaking away from old traditional corrections methods,” Thornell said. “It’s very difficult to sit by and watch the overdoses happen at the rate they are in Maine, knowing there’s a treatment model available that can help, and then not do anything about it.”

Thornell said the DOC is in a rare position to help people struggling with addiction prior to their release, because a correctional setting is free from the complications and distractions that occur outside of prison.

The pilot program launching next month will include inmates at the Maine Correctional Center in Windham, the Bolduc Correctional Facility in Warren and the Southern Maine Women’s Reentry Center, also in Windham.

Maine Correctional Center was chosen because it houses both men and women. Bolduc Correctional and the women’s reentry center were selected because the facilities house inmates who are nearing release or participating in work-release programs.

Inmates participating in the program will receive their addiction medication — Groups prescribes buprenorphine-naloxone — in a similar fashion to which they are given any other medications they would have to take.

Thronell said the medication-assisted treatment participants will receive their buprenorphine-naloxone in a separate area from where other inmates receive medications. The inmates will be given the medication by a nurse and will be supervised by a corrections officer.

To lessen the likelihood that the medications will become prison contraband, Thornell said the DOC has “done their homework” and went to Rhode Island to see how the state’s prisons administer the program.

“It’s not a perfect system. We’ve heard that from every state we’ve talked to,” Thornell said. “But we need to be confident we are putting the right safeguards in place.”

As soon as the DOC starts the pilot program — which will cost about $1 million — on July 1, Thornell said staff will begin planning for expansion. The pilot program will run for about six months before any type of expansion is done. But the goal is to make treatment available at all DOC facilities.

Transitioning treatment upon release

A key part of the medication-assisted treatment program model being put forth, both Thronell and Zelnick said, is that the day participating inmates are released from custody, Groups will connect them with a pathway for continuing treatment.

About 1,300 inmates are released from Maine correctional facilities every year. Of those inmates, only about half are supervised through probation, meaning the DOC has very little insight into an inmate’s life after release.

For inmates participating in the treatment program, the partnership with Groups gives them a resource outside prison to help with the continuation of treatment, employment and housing opportunities, and even assistance with getting health care.

“That’s the critical piece that the Department of Corrections can’t do because we don’t have those referral resources,” Thornell said.

The importance of having a treatment system in place upon release was demonstrated through a partnership between Groups and the Maine State Prison last year, when Liberty was the prison’s warden.

Through the partnership, Groups worked with 42 inmates in the months leading up to their release and put a treatment plan in place that would take effect the day they were released. Zelnick said this even went as far as providing transportation and giving inmates prepaid cellphones to try to break down any barriers to treatment.

Of the 42 inmates who participated, nine months later, 36 are still in treatment with Groups, Zelnick said.

With this model “we can not only make sure that people won’t overdose and die,” Zelnick said, “but we can give them a fighting chance at building the lives that they want to live after being incarcerated.”