Zachary Smith, 30, of Caribou with his mother Cindy Levasseur. Smith filed a civil rights lawsuit in federal court Thursday against the Aroostook County Sheriff's Office and Maine Department of Corrections for not allowing him to continue his prescribed addiction treatment medication when he starts serving a nine-month sentence starting in September. Credit: Gabor Degre

Maine jails and prisons should have figured out long ago how to ensure their inmates could take medications for their opioid-use disorder.

Now, if they don’t start letting inmates take their prescribed medications, such as buprenorphine or methadone, a court may make them.

There are no excuses left.

Last week, Zachary Smith, 30, of Caribou filed a civil rights lawsuit with the backing of the American Civil Liberties Union of Maine. It challenges the Aroostook County Sheriff’s Office and Maine Department of Corrections’ policies of not allowing inmates to continue their prescribed medications while incarcerated.

Smith expects to serve nine months for assault, starting in September, and anticipates having his buprenorphine stopped, which will force him into withdrawal and likely increase his risk of overdose upon his release. He lost his sister to a heroin overdose in 2016 and said he’s afraid he’ll die like she did.

Medication-assisted treatment has been around for decades, is effective and is the standard of care, outside of jails and prisons, for people who are addicted to opioids.

Places outside of Maine that have allowed inmates to continue their prescriptions behind bars and connected them to treatment in the community have seen reduced drug use and reoffense rates.

So what’s the hold-up in this state? There are three main reasons.

First, not enough prison officials are listening to doctors, and continue to run their facilities with the outdated, misinformed understanding that medication-assisted treatment just replaces one drug with another.

In fact, the medications help heal people’s brains, which have been rewired by drugs such as heroin, oxycodone, hydrocodone and fentanyl. Not only do the medications decrease drug use, they reduce overdose deaths, keep people in treatment and prevent the spread of infectious disease.

Second, corrections officials have expressed concern about cost. Inmates lose their Medicaid coverage when they enter facilities, which means counties and the state have to pay for their health care.

But it’s a poor precedent for officials to choose to treat some health conditions over others. And if providing medication reduces reoffense rates long-term, it’s possible the inmate population will decrease and reduce costs as a result.

Third, jails and prisons are afraid of the medications being diverted. Suboxone, a brand name for a medication that includes buprenorphine, is already commonly smuggled into facilities.

It is possible to get high on Suboxone if you take enough of it, but the medication is often smuggled for the very reason it exists: to help prevent inmates’ withdrawal. (To deter abuse, Suboxone also contains naloxone, which prompts withdrawal symptoms when injected.) It’s possible the contraband problem would lessen if inmates were given their prescription.

What’s more, prisons elsewhere have shown it is possible to set up systems to avoid diversion.

Rikers Island in New York, for instance, has had a model medication-assisted treatment program since 1987. To prevent diversion, nurses and corrections officers observe people taking their doses: methadone in liquid form and Suboxone as a sublingual film. Inmates wait, sitting on their hands or with their hands behind their back. Their mouths are checked before they leave.

Some sheriffs are open to the idea of medication-assisted treatment, and they should have leadership from the state on how to carry out and fund effective treatment programs. Fighting lawsuits like Smith’s will only eat up costs that would be better spent on improving inmates’ care and, in the long run, helping to prevent their deaths.

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