The Aroostook County Jail in Houlton. Credit: Joseph Cyr | Houlton Pioneer Times

A federal appeals court has upheld a lower court decision forcing the Aroostook County Jail in Houlton to provide a Madawaska woman addiction treatment medication while she is incarcerated.

The U.S. Court of Appeals for the First Circuit in Boston said in a decision released Tuesday that it found “no abuse of discretion by the district court” in its ruling in favor of Brenda Smith.

“This ruling sends the strongest message yet that jails and prisons need to provide incarcerated people with their doctor-prescribed medicine for opioid use disorder, just like any other medical condition,” said Emma Bond, staff attorney with the ACLU of Maine. “Other facilities should take note and do the right thing, and not wait for further legal action.”

Smith, who is expected to start serving a 40-day sentence for theft this month, had sued the jail to continue providing her physician-prescribed buprenorphine to keep her opioid use disorder in remission while she serves her time.

[Madawaska woman happy court ruled jail must let her receive addiction treatment]

Smith could not immediately be reached Wednesday, but said in an interview last month that she became concerned for her overall health and feared a potential relapse after she learned jail officials could deny her the medication. Smith said that she had multiple relapses before being prescribed buprenorphine and that she has not had a relapse in the five years she has been on the drug.

Before starting her sentence, she read about the American Civil Liberties Union suing the Maine Department of Corrections commissioner and the Aroostook County sheriff in a separate but similar case on behalf of Zachary Smith of Caribou, who wanted to continue taking Suboxone while incarcerated for assault. Brenda and Zachary Smith are not related. Brenda Smith then contacted the ACLU and connected with her lawyers, Andrew Schmidt and Peter Mancuso from Andrew Schmidt Law PLLC.

After a weeklong trial in March in Bangor, U.S. District Court Judge Nancy 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. She noted that the jail “denied Ms. Smith’s requests for buprenorphine without regard to her medical needs and without any true justification.”

The judge also pointed out that corrections staff had successfully provided medication-assisted treatment to a pregnant woman inside the facility without any known problems, and had offered no reason why they couldn’t do the same thing for Smith.

Peter Marchesi, an attorney for the Aroostook County Jail, pushed back at the idea that a ban on medication-assisted treatment is a violation of a prisoner’s rights and argued that medical staff at the jail have the ability to manage prisoners’ withdrawal symptoms. 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.”

The jail filed an appeal in mid-April.

Marchesi could not immediately be reached for comment on the latest ruling Wednesday, nor could Aroostook County Sheriff Shawn Gillen.

Smith’s sentence has been delayed at least twice since the court proceedings began. It is as yet unclear when she will report to jail to serve her time.