Portland – In a landmark decision, a federal judge has ordered the Aroostook County Jail to provide a Madawaska woman with access to medication-assisted treatment (MAT) for her opioid use disorder during her 40-day jail sentence, which is scheduled to begin on Monday.
The 28-page ruling comes in the case of Brenda Smith, who uses physician-prescribed buprenorphine to keep her opioid use disorder in remission. Lawyers for Smith argued that continuing this medication while in jail is essential to treating Smith’s medical condition, as well as preventing painful withdrawal symptoms and an increased chance of relapse, overdose and death upon release.
“This ruling is a breakthrough in the fight against the opioid crisis. The court rightly found that jails must provide necessary medical care for opioid use disorder, just like any other disease. We don’t expect jails to solve the opioid crisis, but the least they can do is not make it worse,” said Emma Bond, staff attorney for the ACLU of Maine, who presented arguments on behalf of Smith. “This ruling is not just about Brenda Smith getting her medication in jail. This is about people in recovery staying in recovery and literally staying alive.”
U.S. District Court Judge Nancy Torresen of the U.S. District Court for the District of Maine heard testimony from Smith as well as medical and corrections experts over the course of a week-long trial in February. In her ruling, Judge Torresen found that denial of MAT would cause serious and irreparable harm to Smith, and would violate the Americans With Disabilities Act (ADA). The ADA prohibits discrimination on the basis of disability, including against people in recovery for opioid use disorder.
Smith has been in active recovery for 10 years. During the first five years, before being prescribed buprenorphine, Smith says she relapsed nearly 20 times. During the last five years, while taking buprenorphine, she has not experienced a single relapse. As Judge Torressen notes in the ruling, “[d]uring that time, Smith has regained custody of her four children, secured stable housing for her family, and obtained employment. She has earned her high school diploma and has begun to take college courses."
Despite the medical consensus that MAT is safe and effective in combating substance use disorder, most Maine jails have policies explicitly prohibiting this treatment for incarcerated people. The Maine Department of Corrections had a similar ban until it was lifted by an Executive Order from Gov. Mills on February 6, 2019.
Noting the high risk of overdose and death for people who suffer from opioid use disorder, Judge Torresen wrote that, "[g]iven the well-documented risk of death associated with opioid use disorder, appropriate treatment is crucial. People who are engaged in treatment are three times less likely to die than those who remain untreated."
Additionally, Judge Torresen found that the Aroostook County Jail’s prior refusal to provide access to MAT was “consistent with the broader stigma against MAT observed by [plaintiff’s expert] Mr. Hayes, who noted that correctional staff often resist providing MAT because they equate MAT to giving addicts drugs rather than giving people treatment.”
“Combating the stigma against medication-assisted treatment for opioid disorders is crucial to overcoming the opioid crisis in Maine and across the country,” said James Monteleone, an attorney with Bernstein Shur. “That means recognizing that medication-assisted treatment is essential medical care for many patients.”
Lawyers from Andrew Schmidt Law PLLC originally filed suit on behalf of Smith in September 2018. Along with Andrew Schmidt and Peter Mancuso from Andrew Schmidt Law PLLC, Smith is represented by Bond and Zachary Heiden from the ACLU of Maine and Monteleone and David Soley from Bernstein Shur. The case was filed in U.S. District Court for the District of Maine, and named Aroostook County and Aroostook County Sheriff Shawn Gillen (in his official capacity) as defendants.
More information about the case, including the order, is here: https://www.aclumaine.org/en/cases/smith-v-aroostook-county