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Madawaska woman wins fight to be treated in jail for opioid addiction

HOULTON, Maine — A Madawaska woman who sued the Aroostook County Jail in federal court has won the right to addiction treatment medication while incarcerated.

U.S. District Court Judge Nancy Torresen ruled late Wednesday night that Brenda Smith must have access to the medication once she begins serving a 40-day sentence for theft at the jail in Houlton on Monday.

“This ruling is a breakthrough in the fight against the opioid crisis,” said Emma Bond, staff attorney for the ACLU of Maine, who presented arguments on behalf of Smith. “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.”

However, Peter Marchesi, the jail’s attorney, said he is disappointed by the ruling and that county officials are evaluating their options. In particular, he said the ruling ignored, or discounted, that medical professionals, not jail staff, determine the needs of inmates and that “no inmate is ever denied the care that the medical professionals determine to be necessary.”

Over the course of a weeklong trial, Torresen heard testimony from Smith as well as medical and corrections experts. In her ruling, Torresen found that denial of medication-assisted treatment would cause serious and irreparable harm to Smith, and would violate the Americans With Disabilities Act. The act prohibits discrimination on the basis of disability, including against people in recovery for opioid use disorder.

Lawyers for Smith argued that continuing the medication while in jail is essential to treating Smith’s medical condition, preventing painful withdrawal symptoms, and an increased chance of relapse, overdose and death.

According to the lawsuit, Smith has been in active recovery for her opioid use disorder for about 10 years with the help of her medication. She has regained custody of her four children, secured stable housing for her family and obtained employment.

In late 2017, however, Smith was convicted of theft and sentenced to 40 days in jail. Her attorney contacted the jail about what procedures needed to be followed to enable her to continue her medication-assisted treatment, but was told Smith would undergo withdrawal and “her symptoms would be treated in accordance with the jail’s withdrawal protocol,” according to court documents.

Attorneys for the jail have pushed back at the idea that a ban on medically assisted treatment is a violation of a prisoner’s rights. Marchesi also previously argued that medical staff at the jail have the ability to manage prisoners’ withdrawal symptoms.

Smith filed a lawsuit and negotiated an extension of her surrender date.

Torresen noted in her decision that prior efforts to take Smith off of her medication had not been successful, and that it was therefore “necessary to her continued health.”

She noted that the jail “denied Ms. Smith’s requests for buprenorphine without regard to her medical needs and without any true justification.”

She also noted that jail officials had suggested they generally try to keep inmates from continuing medication-assisted treatment to prevent diversion of buprenorphine.

On one occasion they provided medication-assisted treatment to a pregnant woman inside the jail, she said, and did so without any known problems.

“The defendants have offered no reason that the same could not be done for Ms. Smith,” Torresen wrote.

James Monteleone, an attorney with Bernstein Shur who also represented Smith in the case, said that “combating the stigma against medication-assisted treatment for opioid disorders is crucial to overcoming the opioid crisis in Maine and across the country. That means recognizing that medication-assisted treatment is essential medical care for many patients.”

Marchesi, the jail attorney, said the decision “ignores, or discounts, critical evidence. Among other things, the decision concludes that the jail has already decided that Ms. Smith will not receive her medication while in the facility, and that the testimony from the jail administrator that she would not be denied the medication was a change of position based upon another case from another state.

“In fact, the jail position has always been, and continues to be, that all inmates’ medical needs are determined not by jail staff but by medical professionals, and that no inmate is ever denied the care that the medical professionals determine to be necessary. Nor is it accurate to say that the ACJ dictates what medical protocols are utilized by medical professionals at the jail. These decisions are made exclusively by trained medical professionals, as they should be.”

He also said that the jail was discouraged that the decision largely ignored decades of law from the U.S. Supreme Court which “required courts to defer to the expertise of jail officials in matters relating to safety and security.”

“The decision conflicts with principles of federalism and the separation of powers, by impermissibly substituting the court’s judgment for that of jail security experts,” Marchesi said.

He said that Houlton jail administrators have been and continue to work on a medication-assisted-treatment program, and that they “believe that the decision unfairly casts its efforts and programs in an unfair and entirely inaccurate light.  

“The Aroostook County Jail intends to pursue all available legal avenues to seek relief from the decision,” he said.

In a separate but similar case in July, the ACLU sued the Maine Department of Corrections commissioner and Aroostook County sheriff on behalf of Zachary Smith of Caribou, who wanted to continue taking Suboxone while incarcerated for assault. Brenda and Zachary Smith are not related.

The ACLU settled that case in September 2018 when the state Department of Corrections agreed to administer the medication-assisted treatment. At the time, Zachary Heiden, legal director with the ACLU of Maine, said the Department of Corrections would pay for the medication, which Smith had said cost his family $144 a month.

Brenda Smith is represented by lawyers Andrew Schmidt and Peter Mancuso from Andrew Schmidt Law PLLC, Bond and Zachary Heiden from the ACLU of Maine, and Monteleone and David Soley from Bernstein Shur.

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