By JB Nicholas, The Appeal

Photo illustration by Kat Wawrykow. Photo from Getty Images.

Photo illustration by Kat Wawrykow. Photo from Getty Images.

Her father sold her drugs. Her sister was strung out. Friends died around her. 

“I shouldn’t have lived,” Brenda Smith, 35, testified in a Maine courtroom in February. “I have had some pretty close people, like close to me, die of a drug overdose.”

But Smith did live, thanks in part to a drug called buprenorphine, better known by its brand name, Suboxone. Along with therapy, she said, it has helped keep her clean since 2009. “It just makes me feel normal,” Smith testified. “Like when I was 17, before I started using drugs.”

That’s why she was determined not to go off it when was she was sentenced in 2018 to 40 days in the Aroostook County jail in northern Maine for swiping $40 cash from a Walmart self-checkout.

From a previous stay in jail, Smith knew that going back meant discontinuing buprenorphine, effectively forcing her to detox from it, increasing her risk of relapse and death from overdose after her release. So before her sentence was scheduled to begin, she sued the county and Sheriff Shawn D. Gillen to continue taking the medication under the Americans with Disabilities Act. 

“I don’t want to lose everything I have worked so hard to achieve in nine years just blown away,” Smith testified.

Like most county jails and state prisons in America, the Aroostook County jail prohibits not just buprenorphine but also methadone and naltrexone, the other two pharmaceuticals approved by the Food and Drug Administration for the medication-assisted treatment of opioid use disorder. 

Sheriff Gillen did not respond to multiple requests for comment. But in response to Smith’s suit, Craig Clossey, the jail’s administrator, testified that buprenorphine was prohibited because of its high potential for abuse.

In an April 30 decision, the First Circuit Court of Appeals agreed with a lower federal court that the Americans with Disabilities Act did indeed require that Smith be allowed to continue taking buprenorphine while incarcerated. The decision joined a November ruling from a federal judge in Massachusetts in Pesce v. Coppinger. As in Smith’s case, the judge in the Pesce case held that denying medication-assisted treatment to an opioid-dependent prisoner likely violates the ADA. 

The ruling in Smith’s case prompted officials in Aroostook County to convert her sentence to a $100 fine, which she paid. She was able to continue taking her medication under the care of her doctor, according to attorneys at the ACLU of Maine, which represented Smith.

Together, the rulings in the Smith and Pesce cases are helping to expand prisoners’ access to drug treatment. The decisions are “a shot over the bow to all jails and prisons across the nation,” said Steven S. Seitchik, who coordinates medication-assisted treatment for the Pennsylvania Department of Corrections.

Lauranne Howard, substance use coordinator for the Rhode Island Department of Corrections, agreed. “This movement is happening across the country,” she told The Appeal. “Inmates have a right to be provided medical care, and that includes appropriate medication.”

Drug overdoses killed more than 702,000 people between 1999 and 2017, the Centers for Disease Control and Prevention reports. The epidemic killed more than 70,000 people in 2017 alone, according to the CDC, a sixfold increase from 1999. Two out of every three overdose deaths are caused by opioids. President Trump declared opioids a national emergency in August 2017.

Substance use is also closely linked to incarceration. Drug-related offenses were a fifth of all reported crimes from 2007 to 2009, and “more than half of state prisoners and two-thirds of sentenced jail detainees met the DSM-IV criteria for drug dependence or abuse,” a 2017 Department of Justice reportfound.

Newly released prisoners, their tolerance lowered by a period of forced abstinence, are particularly vulnerable: They are at least 40 times more likely to die of an opioid overdose than someone in the general population, a 2018 North Carolina study found. 

Medication-assisted treatment, or MAT, is the standard of healthcare for opioid use disorder, according to the federal Department of Health and Human Services

“Offering MAT in correctional settings has been shown to reduce recidivism, overdoses, and criminal activity among people who are incarcerated, and help support them in their recovery from substance use disorders,” said Evan Frost, a spokesperson for New York’s Office of Alcoholism and Substance Abuse Services.

Of the three drugs approved by the FDA for MAT, methadone and buprenorphine are often preferred by treatment professionals to naltrexone because those medications do not require detox to be effective, according to the National Institute on Drug Abuse. They work by restoring “balance to the brain circuits affected by addiction, allowing the patient’s brain to heal while working toward recovery.” Naltrexone blocks the brain’s opioid receptors, denying users the euphoric effect of opioids. 

But the best strategy, according to the FDA, is stocking all three medications. After Rhode Island’s Department of Corrections started making three opioid treatment drugs available in mid-2016, a study found that fewer prisoners died from overdoses after being released.

Seitchik, the MAT coordinator for Pennsylvania’s prison system, where all three drugs are offered, says more options are the key to helping more people get and stay clean. “Client choice is very important to be successful,” he said. “The best form of MAT is whatever form the individual is willing to be compliant with.”

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Olivia McDowellComment