The York County Sheriff’s Office and a local addiction recovery group have won a state grant to bring the gold standard in opiate addiction treatment to a small group of inmates at the jail.

Up to 10 inmates could begin a regimen of medication-assisted treatment before the end of the year through the new pilot program, said Timothy Cheney, principal at ENSO Recovery, which will administer the program at the Alfred lockup and through its outpatient clinic in Sanford.

The program is part of a growing effort to bring evidence-based recovery methods to jails across Maine, where the vast majority of inmates have struggled with addiction or drug-related issues. Already, the state Department of Health and Human Services is working to open similar programs at the Kennebec, Washington and Aroostook County jails, and is in early discussions with Cumberland and Androscoggin counties for analogous medication-assisted treatment programs there, the department said.

“I want to treat the underserved or the not-served,” said Cheney, who has been in recovery from heroin addiction for 37 years, and came out of retirement to found ENSO, which operates treatment facilities in Sanford, Westbrook and Portland. “There’s enough private rehabs. … I want to treat the people who otherwise would die.”

Adding more treatment options for Maine’s incarcerated population is also among the state’s priorities to continue addressing the scourge of overdose deaths, which last year claimed a record 418 lives, many linked to heroin and fentanyl, a powerful synthetic opioid. The $160,000 that will fund the one-year program came from the federal government and was administered by the state DHHS, according to Cheney and a DHHS spokeswoman.

The York County program will primarily incorporate Suboxone, a partially synthetic opiate that helps correct the chemical imbalances in the brain caused by long-term opiate use, which in turn reduces cravings. Suboxone also contains an opiate agonist, which counteracts the euphoric effects of opiates, with the net effect of calming withdrawal and craving symptoms to give patients the stability needed to work on the underlying causes of their drug use.

Coming around to the science and brain chemistry that drives addictive behavior was a slow process for York County Sheriff William King, who said he was dismissive of medication-assisted treatment when he first heard about it a few years ago.

Now, King said he sees substance use disorder as a disease, and that prolonged opiate abuse causes biological damage in the brain that can take years to heal. 

“I felt like, gee, you’re taking someone who has a substance use disorder and you’re giving them another drug. I saw it more as substitution,” King said. “When someone is incarcerated, they’re off opioids, they just can’t get it. However, the damage is sustained. Their brain is not repairing at the rate we need it to repair. The medication-assisted treatment will assist in that repair.”

The long-term goal of the York County effort, Cheney said, is to use the structured environment of life in jail to introduce patients to an intensive outpatient program consisting of medication and three hours of daily group therapy, before graduating to less intense levels of supervision and counseling outside the jail when possible.

Cheney said the program is designed to first use a broad-based assessment to determine a patient’s medical history and past experience with opiates to find the best treatment plan.

The program has been tailored to be flexible to fit both inmates who are awaiting trial or sentencing and are therefore in the jail for an indeterminate amount of time and inmates who are serving defined sentences after their cases have been fully adjudicated, he added.

ENSO’s staff of doctors will prescribe the medication, which will be administered by jail medical staff with the supervision of an on-site clinician staffed through ENSO. The group also has developed a safety protocol in line with national standards to prevent diversion and abuse of the medication within the secure facility, Cheney said.

King said he is working with the county’s insurer and Cheney to finalize the last details of the program before clinicians can begin work inside the jail.

To support the group’s participants after they are released, Cheney said ENSO has purchased house in Sanford for use as a sober home for at least the first 10 participants. When that house fills up, Cheney said he’s prepared to buy another.

“We’re hoping to create a continuum, basically, where people come out of jail, they get employment, they get treatment,” he said.

This is not the first time a York County law enforcement agency has played a critical role in coordinating medication-assisted treatment directly to people who need help. Two years ago in Sanford, Police Chief Thomas Connolly unveiled a pilot program that trained police officers to act directly to screen people with substance use disorder with MAT services through Maine Behavioral Health.

Connolly said about 50 percent of participants were still enrolled and engaged in the treatment when the program ended because funds ran out.