The Maine Department of Corrections will soon offer medication to treat opioid use disorder to everyone in state prisons who needs it.

Advocates have long pressed Maine officials to provide this option in jails and prisons, and the announcement represents an evolution in department policy from just two years ago, when the same medications were banned in correctional facilities.

Under a pilot program, the department currently provides the treatment to roughly 200 people, only those who are about to be released to the community. This expansion will make an estimated 400 people newly eligible for what is considered the gold standard in treatment.

“This is the right thing to do,” Commissioner Randall Liberty said in a news release announcing the change.

Nationally, jails and prisons have historically been slow to adopt medication-assisted treatment. That trend is changing, however, with court decisions and clear evidence to its effectiveness. The Pew Research Center estimated last year that 120 jails in 32 states and prison systems in 10 states were offering evidence-based treatment for opioid addiction, triple the number in 2018.

The American Civil Liberties Union of Maine filed two separate lawsuits in 2018 to get people access to medication-assisted treatment in a jail or prison. In both cases, the plaintiffs had prescriptions for buprenorphine, which is sometimes called Suboxone, but they would not be allowed to take it in the jail or prison where they had been sentenced. They argued the forced withdrawal violated both the Americans with Disabilities Act and the U.S. Constitution, which prohibits cruel and unusual punishment.

In one case, a Caribou man reached a settlement agreement that allowed him to take his medication during his nine-month incarceration. In the other, a federal judge ruled that the Aroostook County Jail had to provide that treatment to a Madawaska woman who had been sentenced to 40 days there, and an appeals court later upheld that decision.

The civil liberties organization reacted positively to the news but said other reforms are still needed.

“Expanding medically assisted treatment (MAT) is an important step DOC is taking to meet its constitutional and legal obligations to provide people in its custody with adequate medical care,” Emma Bond, the legal director, said in a written statement “But at the end of the day, the criminal justice system can’t solve the opioid crisis. We need to shift our priorities – and our funding – from incarceration and punishment to robust community-based treatment options. People with substance use disorder (SUD) need connection, supportive relationships, security, and hope to enter sustained recovery. Arrests, prison time, and criminal records are a barrier to these fundamental pillars of recovery.”

The policy shift in Maine began after Gov. Janet Mills took office in 2019. In her second month in office, she signed an executive order that directed her administration to take a series of immediate steps to address Maine’s opioid crisis. One was a request to her corrections department to explore medication-assisted treatment in state prisons.

That summer, the department announced a pilot program for 100 men and women. The participants were incarcerated at four different facilities and within three months of their release date. The program slowly expanded in the following months to the state’s remaining adult facilities. The department worked with Groups Recover Together, a statewide outpatient opioid treatment provider, and Day One, a substance use and mental health provider in southern Maine.

In February 2020, the Cutler Institute at the Muskie School of Public Service published an evaluation of the pilot, which identified areas for improvement but overall called it successful. Around that time, the department started offering the treatment to people who were within six months of release and to those who were receiving the treatment prior to arriving at the prison.

That limitation meant that only a small fraction of the population was eligible. The department said approximately 200 people are receiving medication-assisted treatment at any given time. The average population in Maine’s prisons in 2020 was roughly 1,750.

This month, the department will expand eligibility to people who are within a year of release. That criteria will expand every three months until November, when all inmates who need the treatment will be eligible. At that point, the department expects the program to treat approximately 600 people, more than a third of the population.

An annual report shows that more than 330 people – 264 men and 69 women – started the treatment in prison and continued it through discharge during the pilot year. Most were incarcerated on drug crimes or property crimes like burglary.

Deputy Commissioner Ryan Thornell said a change in administration made the policy shift possible. He pointed in particular to Mills’ decision to expand Medicaid, a step that former governor Paul LePage had fervently opposed and that has helped more people leaving prison access to health care.

“It gave us as a department the opportunity to prioritize medication-assisted treatment services,” Thornell said. “It was not a strategy that was entertained under the previous administration.”

Thornell said incarcerated people receive both medication and counseling as part of the program. When they are preparing for release, staff helps them sign up for MaineCare and connect with a treatment provider. They schedule a first appointment within days of release and receive training on naloxone, which can reverse the effects of an overdose. During the pandemic, the department has even provided them with a smartphone with a 30-day plan so they don’t miss telehealth appointments or counseling sessions.

Funding for the pilot year totaled $1.2 million, including $450,000 from the state’s Office of Behavioral Health. Funding for the current fiscal year increased to $1.7 million, with $830,000 from that office.

Thornell said the department needed time to establish the program, but the growth was “inevitable.”

“Science and medicine tell us when individuals come into the Department of Corrections, regardless if they have five years or five months, if they suffer from substance use disorder, we know that medication coupled with counseling can stabilize them,” Thornell said. “It’s our obligation to provide that to them, to help them stabilize their lives, address those need areas and transition back into the community in a healthier manner with the medication and services they need.”

The University of North Carolina published a study in 2018 that found people were 40 times more likely to die of an opioid overdose within the first two weeks of release than someone in the general population.

Bruce Noddin, the executive director of the Maine Prisoner Reentry Network, said incarcerated people often turn to treatment because they know people who have died upon their own release from jail or prison. They rarely miss their critical first appointment with a treatment provider in the community, he said, and they work with recovery coaches and other supports before and after their release to make the transition as smooth as possible.

“So many of the individuals that we work with were leaving and then having to scramble to find an MAT provider. … The No. 1 great reason for this is that people aren’t dying,” he said.

Noddin said he still sees gaps in the system, mostly for people who are leaving jails. Some jails have announced similar treatment options, but a Department of Corrections spokeswoman could not provide more details Tuesday. He also hoped the prisons would expand the medication options; while approved alternatives to Suboxone are available in limited cases, they are not common. And he emphasized that the general public still has work to do to eliminate the stigma associated with substance use disorder and its treatment.

“These folks are staying alive, and they’re in recovery,” he said. “They’re contributing parts of our community.”

Maine is still too early to have robust data on outcomes for its participants, Thornell said. But he said they appear to be better for people who have access to treatment while incarcerated. In particular, the annual report from the pilot program showed that none had died from an overdose, even though Maine is on track to set a new record for drug deaths in 2020.

“It’s a very positive step forward, not only for corrections,” Thornell said.

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