Maine's County Jails Spent $12.6M Treating Addiction Last Year

Maine's 15 county jails spent an estimated $12.6 million treating addiction and mental illness among the people in their custody last year, according to a January report from the Maine County Corrections Professional Standards Council — the first time the state's jail-oversight body has tried to put a number on it. Of that total, roughly $9.1 million went to medications for opioid use disorder and more than $3.5 million to mental health care, with per-jail spending ranging from about $180,000 at the Washington County Jail to nearly $1.8 million at the Somerset County Jail.

The figure lands in the middle of a running fight over who pays to run Maine's jails, which are operated by counties rather than the state. Jail administrators increasingly cover addiction treatment with grants, pandemic relief and opioid settlement dollars — money they say will run out, even as the medical needs walking through their doors keep growing.

A court order the counties call an unfunded mandate

Maine's jails have been required to provide medications for opioid use disorder for seven years. The requirement traces to Smith v. Aroostook County, a 2019 case in which federal judges upheld a lower-court ruling that denying a prisoner her buprenorphine treatment would violate the Americans with Disabilities Act. Because the decision came from the First Circuit, it bound every jail and prison in Maine, Massachusetts, New Hampshire, Rhode Island and Puerto Rico. Gov. Janet Mills had signed an executive order encouraging the same shift weeks earlier, and in May 2022 she signed a bill writing the mandate into Maine law.

That 2022 law also created the County Jail Operations Fund, appropriating $20.3 million a year across the 15 jails and capping how much counties could raise property taxes to cover jail costs. County officials have since labeled the treatment requirement an "unfunded mandate" — invoking a clause in the Maine Constitution that bars the state from imposing cost-incurring duties on local governments unless it covers 90 percent of the expense. The state's nonpartisan Office of Fiscal and Program Review did not flag the 2022 bill as a mandate, a distinction that leaves the counties without the constitutional lever they would need.

Gordon Smith, the Mills administration's director of opioid response, said he has long "bristled" at the framing. "They are your residents and it's your constitutional responsibility and certainly a responsibility under the Americans [with] Disabilities Act to treat them for illnesses," he said. "You can't discriminate because the illness happens to be mental illness or substance [use]."

The state's share has shrunk as the bills climb

When the 2022 bill was written, running all 15 jails cost about $100 million a year, and the state's $20.3 million covered roughly a fifth of it, said Tim Curtis, the Somerset County administrator and a member of the corrections council. The council now projects total jail expenditures will top $141 million this year — pushing the same state contribution below 15 percent. Medical costs alone grew nearly 40 percent between 2023 and 2025.

The council's report pinned the budget squeeze on two line items: personnel, which made up about 63 percent of jail expenses and rose roughly a quarter over two years, and prisoner medical costs, about 16 percent of the total and up by more than a third. Lawmakers acknowledged the gap this year with a one-time $4 million appropriation — trimmed down from a proposed $10 million a year. Curtis called it a "band-aid."

"The individuals coming in today, unfortunately, are checking every box," Penobscot County Sheriff Troy Morton told lawmakers in March. "There's violence, there's mental health, there's substance use … We're dealing with people [who are] incredibly expensive to manage."

Grants and settlement dollars fill the gap — for now

To keep the medication-assisted treatment programs running, counties have assembled funding from wherever they can find it. Since 2022, 10 of the agencies that run jails have drawn nearly $5.2 million from the Maine Department of Health and Human Services for opioid medications, according to state contracts. Over seven years, DHHS and the Department of Public Safety awarded six counties just under $1.9 million more in addiction-treatment grants, and Cumberland and Franklin counties each landed a $1 million federal grant through the Justice Department's Comprehensive Opioid, Stimulant, and Substance Use Program.

Counties have also spent about $2.25 million in opioid settlement funds — money from the pharmaceutical companies blamed for the epidemic — on treatment behind bars, a use that critics argue should be reserved for community programs instead. None of those streams is permanent, and the reporting jails submit to the Department of Corrections does not capture grant or settlement spending at all, leaving even the $12.6 million estimate an incomplete picture. Producing it, Curtis said, meant going jail by jail to reconstruct the expenses by hand.

'The largest detox center in the state'

The demand behind those numbers is heavy. Roughly 75 percent of people in Maine's county jails have a substance use disorder and about 60 percent have a mental health condition, according to testimony from the Maine County Commissioners Association. At least 3,446 prisoners received opioid medications last year, a count drawn from just nine of the 15 jails.

Kyle Manahan, the former health services administrator at the Cumberland County Jail — daily population near 400 — estimated that on any given day at least one in ten prisoners is going through detox from opioids, alcohol, benzodiazepines or methamphetamine. "We're probably the largest detox center in the state," he said. Sheriff Kevin Joyce added that the jail is likely also the state's largest mental health institution, holding people the courts have ordered to psychiatric facilities that have no open beds. When prisoners arrive too sick to treat in-house, the county pays to transport and guard them at hospitals: 24 people from the Portland jail were admitted last fiscal year for an average of six days, at a cost of nearly $61,000, and Penobscot County reported a single day-long hospitalization that ran $27,000 in officer overtime.

"The jail is like the emergency room of a hospital," Joyce said. "We don't know who's coming, we don't know when they're coming, and we don't know what condition they're in."

The population keeps growing faster than the alternatives

The pressure is compounded by who is sitting in the jails and for how long. Close to 80 percent of Maine's jail population was awaiting trial last year, up from 66 percent in 2019, as a shortage of defense attorneys and pandemic-era court backlogs stretch out stays. The average daily population across all jails was nearly a quarter higher than in 2021.

Diversion has not kept pace. Maine's 15 treatment and recovery courts, the newest of which opened in Caribou in June, enrolled about 500 people last year — against more than 25,000 booked into county jails. A potential source of relief is stalled in Washington: the state's application for a Section 1115 waiver, which would let jails bill Medicaid for some care in the 90 days before a prisoner's release, remains under federal review as reentry Medicaid programs across the country hit budget-law headwinds. The stakes for getting people onto medication before they walk out are well documented: opioid overdose is the leading cause of death among the recently incarcerated, and after Rhode Island became the first state to offer comprehensive treatment in its jails and prisons in 2016, fatal overdoses among people just released fell 12 percent.