Friday, January 24, 2025

A rural jail has success curbing opioid addictions: 'Jails are an incredible opportunity to help people enter recovery'

Alane O'Connor, DNP
Developing an effective and repeatable treatment for addiction sufferers has proven elusive -- until now. A rural jail in Maine has a solution that could save thousands of lives.

Addiction medicine specialist Alane O’Connor is leading a pilot program that "offers a monthly injection of the drug Sublocade to addicted inmates," reports Kristina Samulewski of The New York Times. The drug works through a time-release mechanism that curbs opioid cravings for a month. O'Connor presents her case for jails as drug recovery centers on the Times' podcast, "The Opinions." An edited synopsis of her discussion is shared below.

The state of Maine is overwhelmingly rural. It also has "one of the highest rates of opioid use disorder in the nation. And people who are incarcerated have an even higher rate, because often times the two go in tandem," O'Connor explains. "Jails are an incredible opportunity to help people enter recovery. It’s a time where motivation is often 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 response to the opioid epidemic's extreme reach in Maine, O'Connor suggested that Somerset County Jail try a different approach for treating inmates with opioid addictions. "I proposed an alternative medication, which I had been using in my community practice since 2017," O'Connor adds. "It’s not a pill. It’s actually an injection into the abdomen, and it’s called Sublocade."

Sublocade is gradually and continuously released into a recovering addict's system. Other opioid drug treatments can include daily methadone and/or Suboxone pills, which people can opt not to take. Sublocade does not offer a choice.

"If I have a patient that I’m prescribing Suboxone to and they don’t have that medication tomorrow or the next day, they are going to get very sick," O'Connor explains. "Sublocade slowly dissolves out of the system, and so patients will start to feel some symptoms after five or six weeks. But there isn’t this cliff that ends where people get very, very sick."

O'Connor says, "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 totally unreasonable expectation."

When Somerset County Jail's Sublocade treatment results were compared with another rural Maine jail where inmates received a daily pill of Suboxone, the results were striking. O'Connor notes, "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. . . . The most important finding was that we had no deaths in the people that were treated in the Sublocade pilot . . . In the comparison jail, unfortunately, there were four deaths."

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