The Penobscot County Jail is more than just a correctional facility. It’s also, by default, the largest detoxification center in the region.
That means it’s the perfect place to pilot a drug treatment program that uses counseling combined with Vivitrol, a monthly shot that makes it impossible to get high on opioids or alcohol, but also requires a period of abstinence before beginning.
The new program, the first of its kind in Maine, is the latest attempt to address the state’s drug epidemic, which took the lives of 376 people in 2016, a nearly 40 percent increase from the previous year. A majority — 313, or 84 percent — of the 2016 deaths were caused by opiates or in combination with an opiate.
Most of the people in the jail either committed a crime while on drugs or committed a crime in order to get drugs, Sheriff Troy Morton said.
“It’s devastating,” Morton said of the effects of illicit drug use. “The folks we see coming in our jail after years of abusing drugs are very, very sick.”
Vivitrol is different from methadone, a narcotic that has been used for three decades as a maintenance tool to help with cravings and withdrawals, and Suboxone, which is a combination narcotic and opiate blocker that satisfies the body’s craving without delivering a euphoric high.
Both medications have shown success in treating opioid addiction, but they can also be used to get high, creating a dangerous situation at the jail, Morton said. Shortly after Morton became sheriff, PCJ stopped offering methadone and Suboxone to inmates, except pregnant women already enrolled in a recovery program.
“It’s a medication that is highly effective. It’s an easier medication to use. It didn’t require daily dosing, and we know since it is an opioid antigen that it truly supports a client not using and slipping back into addiction,” Dr. Chris Pezzullo, the state’s chief health officer, said.
Any licensed prescriber can administer Vivitrol, unlike methadone, which is administered through clinics, or Suboxone, which requires prescribers to have a special U.S. Drug Enforcement Administration license.
Inmates will have to detox and be free of drugs for a month to enroll in the Penobscot County Jail’s program, Morton said.
The one-year pilot is funded by a $350,000 grant from the state Office of Substance Abuse and Mental Health Services. Each shot costs around $900 but Dublin-based biopharmaceutical company Alkermes, Inc., the maker of Vivitrol, provides the first shot for free, Morton said.
The program is a first for Maine, but Vivitrol has been used by a growing number of prisons and jails, according to Matthew Henson, director of public relations for Alkermes, which has U.S. headquarters in Waltham, Massachusetts.
“We have about 450 criminal justice programs in 39 states,” Henson said.
Vivitrol is the brand name of naltrexone, used to treat those addicted to heroin or prescription painkillers, such as Oxycontin and oxycodone, morphine and other opiates. Naltrexone has been used in a pill form since 1984, and was approved by the Food and Drug Administration as an injectible time-release medication in October 2010. It also has been used since 2006 to treat alcohol dependence.
Vivitrol is a cousin to naloxone, often sold as Narcan nasal spray, an opioid antidote that reverses the effects of an overdose, Pezzullo said. It blocks the brain’s opioid receptors and, in turn, reduces drug cravings.
“It’s not an opiate. It’s an opiate antagonist,” Pezzullo said.
PCJ hopes to follow in the shoes of Barnstable County Correctional Facility in Buzzards Bay, Massachusetts, which is slightly bigger than the Bangor jail and for five years has been offering the medication to departing inmates who want it.
The recidivism rate for Vivitrol recipients is around 9 percent since the program started, according to a Pew Charitable Trusts analysis. That’s low compared to the national average of around 77 percent of drug offenders who are arrested again within five years, according to the Bureau of Justice Statistics.
Even so, Morton said, “It’s not a miracle [drug]. It’s a tool.”
The pilot at the Bangor jail is scheduled to start July 10 and will include up to 15 female inmates who have jail terms, or who are awaiting trial, for periods of more than one month.
If the pilot is successful, officials hope to expand the program to dispense it to all exiting inmates who want it, Morton said.
Another key component of the pilot is connecting inmates with services to help with housing, education, transportation and even job placement, once released.
The women who are enrolled in the program must volunteer and will have to show they are serious by attending counseling and participating.
Funded by the grant, Penobscot Community Health Care will dispense the medication and will lead the counseling programs, which will continue after the inmate’s release with the same doctors and staff.
“I honestly believe that is going to be the key to success,” Morton said. “The reason I believe that is because we’ve had programs in this jail for years, but when you get out” those services are gone and people often struggle with enrolling in new programs with new people on the outside.
Morton said those extra steps often create “hurdles” for someone fresh from jail.
When inmates are released, if they qualify, they are enrolled in MaineCare, the state’s Medicaid program that provides health insurance for low-income residents and covers Vivitrol.
In fiscal year 2011, MaineCare spent about $69,294 on 122 Vivitrol injections. The amount has grown every year, and in 2016 a total of $207,731 was spent of 321 injections, Pezzullo said.
The state and jail partnership comes with goals that will be used to prove if the program works.
“The goal is: After release those 15 individuals would have no new criminal charges, and would be in self-directed recovery,” Pezzullo said. “The goal is that they would see improvement with attending school, employment or reunification with their children.”