Later this month, a Caribou man who has been diagnosed with an opioid use disorder will report to the Maine State Prison to serve a nine-month sentence.
Normally, prisoners like Zachary Smith, are not allowed to continue medication-assisted treatment for addiction when they enter jail or prison; some are forced into withdrawal. But Smith's situation is different. For the first time the Maine Department of Corrections will allow him to continue his treatment as part of a settlement of a lawsuit that could have implications for other prisoners.
Zachary Smith has been in recovery for five years. He takes Suboxone, a medication prescribed by his doctor to stave off drug cravings. Along with methadone, it's considered by the medical community to be the standard of care.
Prisons in Maine don't allow the medication, and Smith was fearful about what that could mean for him.
"I lost my sister to opioid addiction and I don't want — I don't want to die,” Smith says.
Smith's sister died of an overdose in 2016 at the age of 36. He says his mother was concerned that if he went to prison without being able to continue treatment, she might lose him, too. Illicit drugs are often smuggled in by prisoners who want to make money on the black market or who are desperate to avoid the painful and prolonged sickness that accompanies acute withdrawal.
"You know, you're self-medicating because they won't give you the correct medications, which is totally against our civil rights,” Smith says.
The lawsuit filed on Smith's behalf by the ACLU of Maine argued that the Department of Corrections was violating the Constitution and the Americans with Disabilities Act by denying treatment to prisoners with opioid use disorder. The ACLU and others argue that providing supervised treatment makes jails and prisons safer by decreasing overdoses along with the demand for contraband.
A study in Rhode Island, for example, found a dramatic drop in overdose deaths among inmates who were offered medication to treat their opioid use disorders.
As part of Smith's case, several medical experts filed declarations in support of continuing medication-assisted treatment during incarceration, and late last month, the Maine Department of Corrections agreed to settle. Smith will remain on Suboxone while he's in prison.
"This particular individual is a bit of an exception,” says Dr. Joseph Fitzpatrick, the commissioner for the Maine DOC.
"He comes in the door with a long history of treatment with a provider, and he goes out the door in approximately a year with that same provider on board,” Fitzpatrick says. “And that's what made it different for us."
Different, says Fitzpatrick, because with an aftercare plan in place, Smith is less likely to relapse when he leaves prison, and the DOC can transfer medication-assisted treatment back to Smith's doctor in Caribou. But with a shortage of treatment providers around Maine, Fitzpatrick says this approach can't be expanded to other prisoners on a widespread-basis right away. He does acknowledge, though, that it marks a shift for corrections that's been slow in coming.
“There are stumbling blocks to this approach and resources are gonna be the biggest stumbling block,” Fitzpatrick says. “I don't think you can consider medically-assisted treatment without a commitment to resources, not just on the inside where you start it, but where it finishes, in the community."
Zach Heiden of the ACLU of Maine says part of the reason there is a shortage of treatment providers is that the state has adopted policies that make it difficult for those providers. He cites the decision to block an expansion of Medicaid to cover the cost of treatment as an example.
But Heiden says around the country, prisons and jails are starting to catch up with what the medical community already knows: that medication-assisted treatment works.
"This has been an issue that we, at the ACLU of Maine, have been concerned about for a long time,” Heiden says. “So, seeing some marked, measurable change in policy, first at the state level, and then at the jails, is something we're very excited about."
Just this week the Maine Department of Health and Human Services confirmed plans for pilot programs for medication-assisted treatment in several jails. And Zachary Smith says he hopes his case will level help standardize treatment so just like prisoners with diabetes, prisoners with substance use disorder will be entitled to their medicine, too.
Originally published October 16, 2018 5:47 p.m.