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

Summary

Podcast Summary: "This Jail in Rural Maine Is a Model for Treating Opioid Addiction"

The Opinions by The New York Times Opinion presents an insightful exploration into innovative approaches for combating the opioid epidemic within the correctional system. Released on January 16, 2025, this episode delves into the pioneering efforts at Somerset County Jail in rural Maine, showcasing how targeted addiction treatment can transform lives and communities.

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1. Introduction to the Opioid Crisis in Rural Maine

Elaine O'Connor, the Director of Addiction Medicine at Somerset County Jail, introduces listeners to the severe impact of the opioid epidemic in Maine's rural areas. Highlighting Maine's "one of the highest rates of opioid use disorder in the nation," O'Connor emphasizes the intertwined nature of incarceration and addiction. She states, “jails are an underutilized opportunity for addiction treatment in America” (00:50).

2. The Pilot Program: Implementing Suppocade

To address the challenge of delivering daily medication treatments like methadone or Suboxone in a jail setting, O'Connor spearheaded a pilot program introducing Sublocade (Suppocade)—a once-monthly injectable medication. She explains, “Suppocade only needs to be injected once a month” (03:33), contrasting it with the daily regimen that often leads to diversion and non-compliance.

3. On-the-Ground Implementation

Greg Ellis, a physician assistant with two decades of experience at Somerset County Jail, collaborates with O'Connor to administer Suppocade. Through a patient like Jamie Vanigraph, who shares his personal struggle with heroin addiction since age twelve, the program's impact becomes evident. Jamie recounts, “When I have to take this shot, it keeps me off drugs and alive, why not?” (08:55).

4. Patient Experiences and Testimonials

Jamie’s journey underscores the program's effectiveness. After years on Suboxone, he faced challenges with daily adherence, leading to relapse during crises. The injectable Suppocade provided a stable blood level of medication, eliminating the daily choice to use or not. Jamie articulates the newfound sense of normalcy, stating, “You wake up normal. You don't think about it. I don't have any cravings” (08:55). This stability is crucial, especially during the high-risk period immediately following release from incarceration.

5. Quantitative Outcomes of the Pilot Program

After a year, O'Connor shares compelling data from the pilot:

• Continuation of Treatment: Individuals treated with Suppocade were nearly three times more likely to continue treatment post-release compared to those on daily Suboxone.

• Reduction in Mortality: No deaths were recorded among Suppocade-treated individuals within a year post-release, contrasted with four deaths in the comparison jail using only Suboxone (08:26).

These findings, published in recent studies, affirm the medication's efficacy in maintaining treatment continuity and reducing fatal overdoses.

6. Addressing Financial and Logistical Challenges

Despite its success, the program faces significant hurdles, primarily the cost of Suppocade, which ranges from $1,500 to $1,700 per injection. This expense is substantially higher than daily pill options, posing a barrier to widespread implementation. O'Connor highlights the Federal Medicaid inmate exclusion policy, which currently prevents funding for incarcerated individuals. However, she notes the possibility of a waiver that could extend Medicaid coverage up to 90 days prior to release, although this change may take one to two years to implement (09:34).

7. The Broader Impact and Future Prospects

O'Connor argues that investing in treatment like Suppocade is economically sensible when considering the costs associated with recidivism and extended incarceration. By reducing re-arrest rates and facilitating smoother re-entry into society, the program not only saves lives but also alleviates the financial and social burdens on the community. She passionately concludes, “When people say, oh, it's too much, think about the obituaries of the four people that died from the other jail. That's the reason we do it” (09:34).

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Conclusion

This episode of The Opinions sheds light on a transformative approach to opioid addiction treatment within the criminal justice system. Through the experiences of dedicated professionals like Elaine O'Connor and Greg Ellis, and testimonies from individuals like Jamie Vanigraph, listeners gain a comprehensive understanding of the challenges and triumphs in addressing addiction in rural Maine. The success of Somerset County Jail's pilot program offers a hopeful blueprint for other institutions grappling with similar crises, underscoring the critical need for accessible, effective treatment options in fostering recovery and reducing the devastating impacts of opioid addiction.

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Note: Times in brackets indicate the timestamp of the quoted material within the podcast transcript.

Transcript

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[Host]

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 is 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, Maine. 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 had 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 Supplicate. Are you calling all of Delta down. 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.

[Jamie Vanigraph]

Hello, I'm Jamie Vanigraph, and I'm getting my Supplicade 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 Supplicade only needs to be injected once a month.

[Greg Ellis]

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

[Jamie Vanigraph]

Since I was about 12 years old.

[Greg Ellis]

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

[Jamie Vanigraph]

Heroin.

[Greg Ellis]

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

[Jamie Vanigraph]

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

[Greg Ellis]

And how did that. That worked well for you?

[Jamie Vanigraph]

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.

[Greg Ellis]

Right, okay. So that's one of the reasons why.

[Elaine O'Connor]

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.

[Greg Ellis]

Have you lay back.

[Elaine O'Connor]

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 come 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?

[Jamie Vanigraph]

Don't know, really.

[Elaine O'Connor]

After we give the patient the supplicade, 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. It 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, is I know it won't 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. Like, how early did you start using substances?

[Jamie Vanigraph]

How old were you so strong substances. 12 years old.

[Greg Ellis]

12.

[Elaine O'Connor]

12 years old, yeah.

[Jamie Vanigraph]

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, that's been.

[Jamie Vanigraph]

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 said, 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 Vanigraph]

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 for them, 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 so when you think about it from that perspective, you know, a $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 think about the obituaries of the four people that died from the other jail. And that's the reason we do it.

[Host]

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 Sohota. The Fact Check team is Kate Sinclair, Mary, Marge Locker and Michelle Harris. Audience strategy by Shannon Busta, Christina Samulewski and Adrian Rivera. The executive producer of Times Opinion Audio is Annie Rose. Dresser.