Jail eyes change in drug policy Methadone use may be allowed

MACHIAS – They arrive at the Washington County Jail dependent on methadone.

In the past, inmates housed at the jail had to be detoxed while doing their time.

And county taxpayers picked up the tab.

Now, the Sheriff’s Department has come up with a proposed policy based on one out of the Penobscot County Jail.

If approved, the new policy would allow inmates to continue with their methadone treatment for at least 14 days and the cost would be borne either by the inmate or by MaineCare.

Methadone is a synthetic opiate that blocks the effects of heroin and other opiates. A major opiate problem Down East is the prescription drug OxyContin, which is diverted for sale on the street.

The policy has to be approved by the county jail’s health officer, Dr. Mark Kaplan of East Machias.

“It’s up to him, really. Then we are going to take it to Discovery House [in Calais] for their approval,” Sheriff Donnie Smith said recently. “It’s pretty bare bones. If you’re in here for a 14-day sentence or less, which is really about a 10-day sentence, you can maintain the current methadone treatment you’re on. That’s for a lot of reasons – it’s easier for us and we don’t have to detox them.”

Discovery House is a Providence, R.I.,-based privately owned company that operates clinics not only in Calais but also in other places in Maine. The Calais clinic has a client base of about 230 people, some of whom end up in the county jail for a variety of reasons.

After 14 days, it’s up to the medical staff whether the inmate is to be kept on methadone or detoxed, Smith said.

Detox does not mean “cold turkey,” Smith said. Rather it’s replacing methadone with other drugs to ease their methadone dependency.

“I won’t be able to talk about it exactly, but I know he goes through a procedure and he prescribes three or four medications that they are on. It’s very expensive for us,” Smith said.

A Clonidine detox patch, according to county records, costs more than $25 per patch.

In April, 20 patches cost the county $527.30. “So if they can stay on methadone while they are here, that is just less of an expense that the county taxpayer has to absorb,” Smith said.

Jail Administrator Capt. Bob Gross said inmates come with a variety of health issues that the county has to take care of.

According to county invoices, which did not show the names of the inmates, the drugs prescribed cover everything from cholesterol medication and sleeping pills to anti-depressant and antipsychotic drugs such as haloperidol, risperidone, paroxetine and quetiapine fumarate. There were also medications such as propoxyphene for pain, as well as heart medication.

But there is another problem, Smith said. If the new policy is adopted, who oversees the actual handing out of the methadone? “Putting the burden of administering methadone on my corrections officers is really tough,” he said.

Under the new policy, he said, a trained medical professional would handle the methadone. “It could be a med-tech, RN or LPN,” he said.

Eventually, the sheriff said, he would like the county to hire a part-time medical person who would be on site seven days a week. “He or she could administer the methadone every day,” he said, as well as other prescriptions. Recently, he and Gross met with the Washington County Commission to talk about hiring someone.

With a part-time person on duty, the jail could institute a daily sick call. Now if an inmate gets sick, it’s up to jail personnel, in consultation with the medical staff, to decide if the person is sent to the emergency room or hospital. The county picks up the tab.

Smith said he realized it was difficult asking the commission to hire someone when so many people in the county did not have health care, but state law requires that jails provide medical care.

“The issue is do we do it correctly or do we do it incorrectly and get sued,” he asked. “It’s pay now or pay later.”

The sheriff estimated that his health-care costs would drop if there were fewer trips to the emergency room.