Replay: This Jail in Rural Maine Is a Model for Treating Opioid Addiction

Summary

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Episode Overview

Title: Replay: This Jail in Rural Maine Is a Model for Treating Opioid Addiction
Podcast: The Opinions by New York Times Opinion
Date: August 27, 2025
Main Theme:
The episode explores a pioneering opioid addiction treatment program at the Somerset County Jail in rural Maine, focusing on the use of monthly injectable medication (Sublocade) over traditional daily treatments like Suboxone. Host Elaine O’Connor (director of Addiction Medicine at the jail) walks listeners through the program's inception, mechanics, and outcomes, highlighting the potential of jails as intervention points and the challenges posed by funding and stigma.

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Key Discussion Points & Insights

1. Background: The Opioid Epidemic in Rural Maine

• Maine's opioid crisis: One of the highest rates of opioid use disorder in the nation, with especially acute problems among incarcerated populations.
• Elaine O’Connor’s perspective:
  • Jails present critical, often underutilized opportunities for addiction treatment.
  • Entry to jail can be a moment of heightened motivation for recovery.
• Quote:
  • “Jails are an incredible opportunity to help people enter recovery. It’s a time where motivation is often very high.” — Elaine O’Connor [01:10]

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2. The Pilot Program: Sublocade Injections

• Medication-assisted therapy:
  • Traditional daily treatments (Methadone, Suboxone) are hard to deliver in jail settings.
  • Sublocade (once-a-month injection) is proposed as an alternative.
• How it works:
  • Sublocade is injected into the abdomen and dissolves slowly, maintaining steady opioid blockage for 28–44 days.
  • Advantage: Eliminates daily choice, which is vulnerable to relapse triggers.
• Greg Ellis (Physician Assistant), Jamie Van de Graaff (participant):
  • Jamie shares struggles with daily Suboxone: days when he’d skip the dose and relapse.
• Quote:
  • “The one transformative difference is really that Sublocade only needs to be injected once a month.” — Elaine O’Connor [03:31]

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3. Inside the Treatment Process

• Administration:
  • Procedure explained—from alcohol prep to observing patients for band-aid diversion after injection.
  • Notable moment: After injection, patients feel a small bump, which reassures them the medication is present.
• Impact on experience:
  • Steady blood level reduces withdrawal and cravings.
• Quote:
  • “After we give the patient the Sublocade, we don’t need to see him again for another month ... Patients actually find the presence of the bump to some extent reassuring.” — Elaine O’Connor [05:49]

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4. Personal Stories & Emotional Insights

• Jamie Van de Graaff’s story:

  • Started using heroin at 12, often introduced by family.
  • Repeated cycles of relapse due to life stress and medication lapses.
  • Overdosed multiple times; credits program with giving him a shot at normalcy and hope.

• Quotes:

  • “This is the first time you’ve been sober since you were a kiddo. How early did you start using substances?” — Elaine O’Connor [07:52]
  • “Not waking up, like, oh, when am I gonna get it?... I don’t have any cravings. And that’s the biggest thing we’re kind of fighting for.” — Jamie Van de Graaff [08:54]
  • “If I need to take this shot for the rest of my life, I will. For me, if it keeps me off drugs and alive, why not?” — Jamie Van de Graaff [09:29]

• Societal stigma:

  • O’Connor emphasizes no one aspires to addiction; criticizes public misconception that stopping is simply a matter of will.
  • Quote:
    • “I’ve never, ever met anyone who said, I want to grow up and be addicted to drugs and end up in jail.” — Elaine O’Connor [09:33]

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5. Program Outcomes – Data and Results

• Pilot study:
  • Compared Sublocade recipients at Somerset to a control group on Suboxone in another rural jail.
  • Outcomes were superior for the injection group:
    • Nearly three times as likely to continue treatment post-release.
    • No deaths in Sublocade group within a year of release (vs. four in Suboxone group).
    • Reduction in medication diversion and side effects; patient preference for injection.
• Quote:
  • “We found that people treated with Sublocade were almost three times as likely to continue treatment when they leave the jail... Clearly, the most important finding was that we had no deaths in the people that were treated in the Sublocade pilot.” — Elaine O’Connor [11:01]

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6. Barriers: Cost & Policy Challenges

• High financial costs:
  • Sublocade: $1,500–$1,700/month, 4x more expensive than pills.
  • Local counties must shoulder drug costs due to Medicaid exclusion for incarcerated individuals.
• Policy update on the horizon:
  • New Medicaid waiver may cover inmates for 90 days before release—implementation likely 1-2 years off.
• Economic argument:
  • Treating opioid use disorder in jail reduces recidivism and re-incarceration costs long-term.
• Quote:
  • “When people say, oh, it’s too much, why would we spend that much on any individual? I think about the obituaries of the four people that died from the other jail. And that’s the reason we do it.” — Elaine O’Connor [13:14]

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Memorable Moments and Quotes (with Timestamps)

• [01:10] Elaine O’Connor: “Jails are an incredible opportunity to help people enter recovery. It’s a time where motivation is often very high.”

• [03:31] Elaine O’Connor: “The one transformative difference is really that Sublocade only needs to be injected once a month.”

• [04:10] Jamie Van de Graaff: “There’d be times I’d wake up and having a bad day or a crisis and I’d say, hey, I don’t want to take my Suboxone today. And then I’d switch back to using heroin.”

• [08:54] Jamie Van de Graaff: “Not waking up, like, oh, when am I gonna get it? ... I don’t have any cravings. And that’s the biggest thing we’re kind of fighting for.”

• [09:33] Elaine O’Connor: “I’ve never, ever met anyone who said, I want to grow up and be addicted to drugs and end up in jail.”

• [11:01] Elaine O’Connor: “People treated with Sublocade were almost three times as likely to continue treatment when they leave the jail... We had no deaths in the people that were treated in the Sublocade pilot.”

• [13:14] Elaine O’Connor: “I think about the obituaries of the four people that died from the other jail. And that’s the reason we do it.”

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Important Segments / Timestamps

• Introduction and Maine opioid context: [00:48–02:45]
• Medication details and pilot rationale: [02:45–04:46]
• Jamie’s personal story / Inmate experiences: [04:46–09:33]
• Outcome data and pilot results: [09:33–11:30]
• Barriers to expansion and policy critique: [11:30–13:14]

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Tone and Takeaway

The episode is empathetic, hopeful, and sober about policy hurdles. The speakers use clear, relatable language, centering patient dignity and emphasizing that treating opioid use disorder is a matter of life, death, and social responsibility. The Somerset County Jail model shows transformative potential for addiction treatment nationwide—if challenges of cost and policy can be addressed.

Transcript

[Elaine O'Connor]

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[Podcast Narrator]

This is the Opinions, a show that brings you a mix of voices from New York Times opinion. You've heard the news. Here's what to make of it.

[Elaine O'Connor]

My name's Elaine o', Connor, and I'm the director of Addiction medicine at Somerset County Jail in Maine. For about three years, I've been running a pilot program at the jail to combat the opioid epidemic which has really ravaged rural communities, especially in places like Maine. As an addiction medicine specialist, it's just so clear to me that jails are an underutilized opportunity for addiction treatment in America. So this is Somerset County Jail and the sheriff's department. Everybody drives big trucks. This is rural Maine. Maine has one of the highest rates of opioid use disorder in the nation. And people who are incarcerated have an even higher rate because oftentimes the two go in tandem. We're headed into the Somerset County Jail, Madison Main. So this is the entrance. This is for weapons clearing only. In other words, don't put your trash or your cigarettes in there because that's where the guns get emptied. And then this lets us in. People enter the jail immediately after arrest and are cared for really from the very first moment they're there. So jails are an incredible opportunity to help people enter recovery. It's a time where motivation is often very high. But I think we don't do a very good job really, across the country in giving people access to the treatment that they need. In general, when we treat opioid addiction, we typically use a daily medication, which is typically either methadone or Suboxone. But jail is complex in terms of a setting to deliver daily medication. The sheriff really wanted a solution to the problem, so we really started brainstorming ideas. And I proposed an alternative medication, which I been using in my community practice since 2017. It's not a pill, it's actually an injection into the abdomen, and it's called Supplicade. Are you calling all of Delta down or I don't even know where existing. Once a week, I visit the jail to interact with individuals who are enrolled in the program and to work with other members of the medical staff who are providing the care.

[Greg Ellis]

I'm Greg Ellis, I'm a physician assistant. I've been working now at the Somerset county jail for about 20 years and work with Elaine in the program.

[Elaine O'Connor]

So we're bringing an inmate down from his pod to get his supplicate injection. So they come down once a month to the medical facility to get their injection. And it's really nice because, you know, there's a lot of privacy with that. Hello.

[Jamie Van de Graaff]

I'm Jamie Van de Graaff and I'm getting my sublocade shot today.

[Elaine O'Connor]

It's similar to methadone and Suboxone in the sense that it controls cravings and withdrawal symptoms. But the one transformative difference is really that supplocade only needs to be injected once a month.

[Greg Ellis]

All right, Jamie. So I'm Greg Ellis, the PA here. So how long have you been using?

[Jamie Van de Graaff]

Since I was about 12 years old.

[Greg Ellis]

12 years old. Injecting? Yes, yes. And your drug of choice typically?

[Jamie Van de Graaff]

Heroin.

[Greg Ellis]

Heroin. So have you been on Suboxone before? Have you been in a treatment program before?

[Jamie Van de Graaff]

Yes, I've been on Suboxone for the past four years.

[Greg Ellis]

And how did that. That worked well for you?

[Jamie Van de Graaff]

It did at times. And then like the biggest thing why I wanted to do this shot is like times I'd wake up and having a bad day or a crisis and I'd say, hey, I don't want to take my Suboxone today. And then I'd switch back to using heroin.

[Elaine O'Connor]

Right, okay.

[Greg Ellis]

So that's, that's one of the reasons.

[Elaine O'Connor]

Why Jamie had been on the daily pill, Suboxone, so he could opt out from taking the medication each day. And you just can't do that with the injectable medication. It's in your system, it's working. And that daily choice doesn't exist. Supplicate is administered into the abdomen. It's injected right under the skin, kind.

[Greg Ellis]

Of six pack muscles that's, you know, kind of a layer of fat there that absorbs it. I like to start with just marking with a marking pen first. So just like an alcohol prep, just kind of clean the skin so you can feel a pick here, an injection just in the skin itself. So inject into the skin. I try to inject slowly. Everything's good. Don't feel it at all.

[Elaine O'Connor]

It goes from being sort of a very thick maple syrup type substance into a hardened object very quickly. And you can actually feel that little bump under the skin. And then it just slowly dissolves over the course of the next several weeks in their system.

[Greg Ellis]

So we have to have the inmate sit for five minutes and then take their band aid back because there's reports of people going back and selling their band aid for what little supplicade would get onto the band aid after the injection. Questions at all?

[Elaine O'Connor]

No, really, after we give the patient the sublocade, we don't need to see him again for another month. And at that time, the bump from the previous injection is just about gone. Patients actually find the presence of the bump to some extent reassuring. Tells them that the medication is working because it goes down in size over time. The critical piece with sublocade is that the medication is effective in the system for really 28 to 44 days. So a long time. The patient's experience is much different than with the daily medication because their blood level is very constant throughout. So if I have a patient that I'm prescribing Suboxone to and they don't have that medication tomorrow or the next day, they are going to get very sick. Sublocade slowly dissolves out of the system. And so patients will start to feel some symptoms after, you know, five or six weeks. But there isn't this cliff that ends where people get very, very sick. Jails tend to be a little bit of a revolving door. People come in and out of the facility. Some people are arrested and released within a matter of a few hours. Others are there for months. So these unpredictable release dates, people will leave and go into the community and have that medication on board as really the critical bridge to successful re entry during that high, high risk time. That's the first two weeks that patients leave the facility. Opioid withdrawal is horrible to see. And I see it all the time where patients are sweating profusely, they're vomiting, they're having diarrhea, they're in so much pain, they can't sleep. And what patients will often say is, I know it won' kill me, but I want to die when I feel that way. And when people are very, very sick, they'll do anything to feel better. And the real fear is that they'll use fentanyl or heroin. Jamie's story is like so many of the other folks that we take care of, this is the first time you've been sober since you were a kiddo. How early did you start using substances? How old were you?

[Jamie Van de Graaff]

So strong substances 12 years old.

[Greg Ellis]

12 years old, yeah.

[Jamie Van de Graaff]

A family member got me introduced and on and off and then just real heavy once I was about 18, 19.

[Elaine O'Connor]

It's oftentimes friends or family members that introduce them to drugs at an incredibly young age. And you just think about the trauma that goes along with that, and really all the challenges that we see in rural Maine.

[Jamie Van de Graaff]

That's been. My biggest issue is being on Suboxone. Something will happen, or I'm going through something, a relationship breakup or a family member passing, and I say, no, just don't take it. And I start using my other drugs. So. And, you know, I've overdosed, and thankfully, I'm here still. And some of my friends, if they had this program, they'd still be here.

[Greg Ellis]

And some of the feedback that I've heard from you guys is just that I feel normal again, like for the first time. It's not always kind of chasing something every day.

[Jamie Van de Graaff]

Yeah. Not waking up, like, oh, when am I gonna get it? You know, you wake up normal. You don't think about it. I don't have any cravings. And that's the biggest thing we're kind of fighting for. As an addict myself, is just to live a normal life and be a normal person. I've lost a lot of people because of addiction in my family. And, you know, it's just. It's hard. Once I'm out, I'll definitely be continuing my shots. And if I need to take this shot for the rest of my life, I will. You know, some people have to have that kind of security form, you know, and for me, if it keeps me off drugs and alive, why not?

[Elaine O'Connor]

I've never, ever met anyone who said, I want to grow up and be addicted to drugs and end up in jail. It's just not a reasonable thing to even think. And yet I think society believes that patients can just make the choice to stop using tomorrow. And if they don't have the appropriate medical treatment, that's just a totally unreasonable expectation. After a year of administering the medication, we compared the outcomes of people treated at Somerset County Jail with inmates in a rural main jail, where they were receiving only Suboxone, the daily pill option. The two jails were as similar as we could possibly make them in the sense of size, in the sense of rurality. And the medical care was delivered by the same organization in both facilities. The results of our pilot project were published, and they really show the incredible promise of the medication. We found that people treated with sublocade were almost three times as likely to continue treatment when they leave the jail. Relative to folks who were treated with the daily medication, there was a clear lack of diversion and side effects. The medication was well tolerated, and patients liked it. Clearly, the most important finding was that we had no deaths in the people that were treated in the sublocade pilot when they were released from our facility. And we tracked them for up to a year after they were released. And in the comparison jail, unfortunately, there were four deaths. So we know this drug works. We know we're changing lives, but really the only thing standing in our way right now is how much the drug costs. The cost of the monthly injection Supplicade is about 1,500 to 1,700, and that's about four or more times as much as the daily pill would cost. And, you know, $1,700, that's as much as some people make in a month. There are some sources of federal fund available for this medication, but it's typically not for people that are incarcerated. Federal Medicaid has what's called an inmate exclusion policy, which does not allow for federal Medicaid funding to cover individuals who are incarcerated. So counties need to pay that themselves. But that could change. There's a waiver that allows for Medicaid coverage of incarcerated individuals up to 90 days prior to release, which is really most of our patients. It will take probably at least a year, maybe two, to be implemented. So we still have a window of time where this is going to be difficult to provide this care. It's really clear that treating people's substance use disorder while they're incarcerated leads to many benefits, including they're less likely to come back into the correctional system, less likely to be arrested. And. And so when you think about it from that perspective, you know, $1,700 shot is well worth it compared to what it would cost to incarcerate an individual even for one month. I write grants all day some days because I'm so committed to this program, because I see the promise of this medication in a correctional facility. And when people say, oh, it's too much, why would we spend that much on any individual? I think about the obituaries of the four people that died from the other jail. And that's the reason we do it.

[Podcast Narrator]

If you like this show, follow it on Spotify, Apple, or wherever you get your podcasts. This show is produced by Derek Arthur, Sophia Alvarez, Boyd Vishaka Durba, Phoebe Lett, Christina Samulewski, and Gillian Weinberger. It's edited by Kari Pitkin, Allison Bruzek and Annie Rose Strasser Engineering, mixing and original music by Isaac Jones, sonia Herrero, Pat McCusker, Carol Saburo and Afim Shapiro. Additional music by Amin Sahota. The Fact Check team is Kate Sinclair, Mary, Marge Locker and Michelle Harris. Audience strategy by Shannon Busta, Christina Samulewski and Adrienne Rivera. The executive producer of Times Opinion Audio is Annie Rose Dresser.

[Elaine O'Connor]

Sam.