With a worsening opioid crisis and a string of deaths in Maine jails, the Cumberland County Jail hopes to improve substance abuse treatment options with a slow and steady approach.
One of two Maine jail deaths within days of each other at the beginning of the month took place at the largest jail in the state, on County Way in Portland.
It occurred as the number of residents involved in medication-assisted treatment, or MAT, at the jail has more than doubled in the last month. MAT is a combination of therapies in conjunction with medication to treat opioid addiction and reduce withdrawal symptoms.
There are approximately 50 residents on MAT at the jail, compared with about 20 a month ago. But despite the demand, officials at the jail are being careful to avoid expanding the program to more people than it can handle, Sheriff Kevin Joyce said.
They’ve incrementally allowed more jail residents to access the treatment and 50 is only a fraction of how many may actually want it. The expectation is the number could be as many as 120 of the total 250 residents, and Joyce said it could end up being even more because as many as 80 percent of residents at CCJ are suffering from substance use disease or some form of mental illness.
“Are we poised to be able to handle that?” Joyce said. “I’m not sure we are.”
The more immediate response may be to expand and open care options as quickly as possible, but Joyce is confident that moving slowly is the best way to go.
He said his aim is to be able to fully offer the service in 2023. The jail recently added a new MAT coordinator and a new nurse, but resignations and other general staffing shortages have resulted in setbacks in implementing the care.
“The biggest mistake you can make is rushing right in without getting services lined up inside the jail – and, most importantly, outside the jail,” Joyce said.
In Maine, access to MAT had previously been restricted to jail residents who were already involved in a program on the outside. This was changed by the state in February 2021, to allow access to anyone who wanted it.
Since then, the jail has been working up to meeting that level of accessibility, although the coronavirus pandemic and staffing problems have created hurdles.
“That is something that we’ve struggled to do because we don’t have the staff to do it,” Capt. Donald Goulet said. About five months ago, the jail started organizing treatment for residents in drug court upon their release, so they can go directly to a recovery center or something similar to keep their treatment going once they get out, he said.
Maintaining that care is an important step as the opioid crisis continues to worsen, according to Leslie Clark, executive director of the Portland Recovery Center. It’s particularly worse when it comes to the number of deaths and overdoses that are due to the increasing availability of fentanyl.
Clark said the opioid epidemic is at a “crisis level,” and the transition in and out of jail can be a very vulnerable time for someone in recovery. More people have been seeking help at the recovery center, she said, at the same time jail officials have seen more people coming in with substance use disorders.
Time is also a barrier to the treatment the jail can provide. The average resident’s stay in Cumberland County is only around 10 days, according to Goulet, so it can be difficult to make any progress. He added that state prisons are typically more productive as a result, since they keep residents for a minimum of a year.
The first steps have begun, Goulet explained, by offering treatment to people who have been involved in medicated treatment in the past and hope to start again.
“We want to walk before we can run,” Goulet said, “because if we just run, we (will) miss things.”
Readily prepared new medical staff bodes well for continuing to expand treatment options at the jail, but general staffing struggles are lingering. The jail is down about 70 staff from the optimal number of around 125, officials said.
With staffing struggles in mind, the question becomes whether jails can provide the help that so many need. Over time, they have become treatment centers by default, according to Clark.
She said jails are “in a situation where they’re expected and needing to provide adequate treatment to people, but that’s not what they’ve been set up to do.”
In light of all this, Jan Marie Collins, assistant director of the Maine Prisoner Advocacy Coalition, said she expects trends – and deaths – to continue given the worsening of the opioid epidemic.
Nicole Turner, 35, of Biddeford, was found dead in her cell at York County Jail on July 5, likely due to an overdose, according to law enforcement. At CCJ, 65-year-old Kevin Whitford of Sanford was found a few days later; the cause of his death is still under investigation by the Office of the State Medical Examiner.
Turner was successful in many ways, Collins said, but like a lot of people who suffer from substance use disorder, she experienced trauma during her childhood, and somewhere along the way, the system failed her. York County Sheriff’s Department officials said Turner hadn’t begun her enrollment in MAT, but had been at the jail for 10 days and was being evaluated for it.
Collins argued that if jails can’t give residents adequate treatment, programs like MAT should be separated from jails entirely.
“People shouldn’t be incarcerated for addiction, they should be treated for addiction,” she said. “It’s a medical problem, it needs a medical solution.”
She acknowledged progress has been made in recent years, but said there’s still plenty of work to be done.
“Maine is working hard,” Collins said, “but it has a long way to go.”