The Pathways to Recovery consortium is positively impacting Somerset County through comprehensive partnerships, networking, and expanded opportunities for engagement, treatment, and recovery. Our consortium partners include law enforcement and corrections, behavioral health centers, community action programs, hospitals, and health centers. Somerset County has approximately 50,000 residents and extends from central Maine to the Canadian border. Some of our challenges include limited access to broadband internet, few rural treatment sites or services, insufficient public transportation, and deep generational poverty. Along with our profound challenges, Somerset County has a kind, caring, and compassionate network of people, who work tirelessly to support our community and those with substance use disorders (SUDs).
One of our most innovative and promising projects is at the Somerset County Jail. Many individuals with opioid use disorder (OUD) experience episodes of incarceration, typically in county jails. In ME, up to 75% of male admissions and 86% of female admissions to correctional facilities require treatment of an SUD. Providing OUD treatment during incarceration reduces the risk of drug overdose death post-release yet providing this treatment in county jails is often difficult due to the significant shortages in corrections officers (up to 50%), time required to oversee medication administration, and risk of diversion.
In response to this challenge, Maine Medical Center’s Dr. Alane O’Connor worked with Sheriff Dale Lancaster, Somerset County Jail Programs Manager Michael Welch, and many other members of the medical and corrections team to develop a 1-year pilot project to expand access to OUD treatment using extended-release buprenorphine (XRB). Rather than the traditional daily administration of sublingual buprenorphine, XRB is a monthly injection that provides OUD treatment for at least 28 days. While the cost of XRB is high, Somerset believes these costs will be largely offset by the substantial reduction in staffing time. Using XRB also enables individuals to continue receiving treatment for up to 28 days post-release, giving them more time to connect with community treatment resources.
The first study using XRB in a correctional system (an urban New York facility) demonstrated XRB’s comparative effectiveness, as those on XRB had substantially fewer jail medical visits, higher rates of treatment retention and negative urine drug screens post release, and lower rate of recidivism. Patient experience at the NY facility was largely positive as the medication was well tolerated and enhanced patient privacy. Somerset County Jail’s experience has been similar, with a female patient recently stating, “I was glad I took the shot [XRB]. I feel level. It doesn’t remind me every day that I am on suboxone and that is a good thing. [Post-release] I won’t have to worry about whether my script got filled, having it on me or losing it. This will let me focus on what I want and live a structured life.”
Somerset County Jail is the first correctional facility in ME to offer a comprehensive XRB treatment plan and only the second in the nation. As part of its work, the Somerset team is writing a best practices manual for the use of XRB in a correctional setting; upon completion, the manual will be available publicly. Somerset is incredibly grateful to ME’s Director of Opioid Response, Office of Behavioral Health, and the HRSA/RCORP Pathways to Recovery project and consortium as the project would not have been possible without their support.
Cheng, A., Badolato, R., Segoshi, A., McDonald, R., Malone, M., Vasudevan, K.,…Tofighi, B. (2022). Perceptions and experiences toward extended-release buprenorphine among persons leaving jail with opioid use disorders before and curing COVID-19: an in-depth qualitative study. Addiction Science & Clinical Practice, 14(4). ttps://doi.org/10.1186/s13722-022-00288-4.
Green, T.C., Clarke, J., Brinkley-Rubinstein, L., Marshall, B.D., Alexander-Scott, N., Boss R., Rich, J.D. (2018). Post-incarceration fatal overdoses after implementing medications for addiction treatment in a statewide correctional system. JAMA Psychiatry, 75(4), 405-407. doi:10.1001/jamapsychiatry.2017.461.
Lee, J.D., Malone, M., McDonald, R., Cheng, A., Vasudevan, K., Tofighi, B.,…MacDonald, R. (2021). Comparison of treatment retention of adults with opioid addiction managed with extended-release buprenorphine vs daily sublingual buprenorphine-naloxone at time of release from jail. JAMA Network Open, 4(9), e2123032. doi:10.1001/jamanetworkopen.2021.23032.