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

Episode Date: August 27, 2025

Maine has one of the highest rates of opioid use disorder in the nation. But a program at a rural Maine jail initiated by an addiction medicine specialist, Alane O’Connor, is offering hope and saving lives. She’s spearheading a pilot program that offers a monthly injection of the drug Sublocade to addicted inmates, which curbs opioid cravings continuously for a month. In this episode, she argues, “jails are an incredible opportunity to help people enter recovery.”This episode originally aired January 16, 2025. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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. 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 in 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 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 suboxin. 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 the 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. I'm Greg Ellis. I'm a physician assistant. I've been working now at the San Francisco County Jail for about 20 years and work with Elaine in the program. So we're bringing an inmate down from his pod to get his sublicate 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. I'm Jamie Vanagraph, and I'm getting my sublicate shot today. It's similar to methadone and Suboxin in the sense that it controls cravings and withdrawal symptoms. But the one transformative difference is really that sublacade only needs to be injected once a month. All right, Jamie. So I'm Greg Ellis, the PA here. So how long have you been using? Since I was about 12 years old. 12 years old. Injecting, yes?

Yes. And your drug of choice typically? Heroin. Heroin. Okay. So have you been on Suboxone before? Have you been in a treatment program before? Yes. I've been on Suboxone for the past four years. And how did that? That worked well for you? 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 Suboxin today. And then I'd switch back to using heroin. Right. Okay. So that's one of the reasons why... Jamie had been on the daily pill, suboxin, so he could opt out from taking the medication each day.

Then 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. Can you have your layback. Sublicate is administered into the abdomen. It's injected right under the skin. Kind 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. It comes in 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.

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. So we have the inmates 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 sublacate would get on to the Band-Aid after the Yenai. injection. Questions at all? Um, I don't know, 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. 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 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 Suboxin to, and they don't have that medication tomorrow or the next day, they are going to get very sick. Sublicade 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 reentry 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'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. take care of. And this is the first time you've been sober since you were a kiddo.

Like how early did you start using substances? How old were you? So strong substances, 12 years old. 12 years old. Yeah, a family member got me introduced and on and off. And then just real heavy once I was about 18, 19. It's oftentimes friends or family members that introduced 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 my biggest issue is being on Suboxin, 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 then 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. 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.

Yeah. Not waking up, like, oh, when am I going to 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. You know, 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, Well, 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? 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 good. 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 Suboxin, 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 sublacade 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 funding 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 about the obituaries of the four people that died from the other jail.

and that's the reason we do it. 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, Veshaka, Fiby Lett, Christina Samuoski, and Jillian Weinberger. It's edited by Kari Pitkin, Alison Bruzek, and Annie Rose Strasser. Engineering, mixing, and original music by Isaac Jones, Sonia Herrero, Pat McCusker, Carol Sabarrow, 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 Samuiluski, and Adrian Rivera.

The executive producer of Times Opinion Audio is Annie Rose Dresser.