Brian Sonenstein is a reporter covering incarceration and the prison abolition movement. He is a columnist for the Portland Phoenix, co-founder of, and co-host of the Beyond Prisons podcast.

Zachary Smith, a Caribou resident more than five years into recovery from opioid use disorder, argues that the policies of the Maine Department of Corrections and Aroostook Sheriff’s Office will endanger his life when he is incarcerated in September.

Smith is suing the agencies for terminating his Medication-Assisted Treatment (MAT) when he begins his sentence later this year. MAT is a combination of counseling and medication such as buprenorphine under the supervision of a physician. The medication blocks the body’s opioid receptors, suppressing cravings and withdrawal.

The medical consensus is that MAT is the best treatment option for people with opioid use disorder and it has demonstrated success in supporting recovery over the long term. It’s clinically proven to be dramatically more effective than detox, which Smith will be forced to endure while imprisoned.

The ACLU of Maine, which filed the lawsuit, argues that prohibiting MAT will force Smith into withdrawal in violation of the Americans with Disabilities Act and Eighth Amendment protections against cruel and unusual punishment.

They point out the policy makes it much less likely that Smith will continue treatment after he is released, and that those who are not in treatment are three times more likely to die.

Zach Heiden, one of Smith’s attorneys at the ACLU, hopes the case will ”help move us all closer to acknowledging addiction is a chronic medical condition.”

“Our criminal justice system can’t solve the opioid crisis,” Heiden told the Phoenix, “but the least it can do is not make matters worse.”



Smith’s case is in many ways representative of the situation facing people incarcerated in Maine and highlights the absurd cruelty of the refusal to provide MAT.

In addition to opioid use disorder, Smith is diagnosed with co-occurring disorders of anxiety and severe depression. When forced into withdrawal, he will likely experience severe pain, nausea, tremors, sweating, dizziness, dehydration, and vomiting. He’ll also experience psychological symptoms such as decompensation, severe depression, and suicidality.

Because forced detox does not stem cravings, and because of his body’s significantly diminished tolerance for opioids afterward, people in Smith’s position are at higher risk of relapse, overdose, and death.

MAT has been found to reduce this risk of mortality by 75 percent, the lawsuit notes.



Unfortunately, rather than medical professionals, it is law enforcement on the front lines of a public health crisis involving a chronic brain disease, and so providing proper and humane medical care is not a top priority.

Some officials have justified their refusal to provide MAT by arguing people who use opioids simply need to clean up their acts, as though someone could decide on a whim they are no longer profoundly sick.

“Methadone and Suboxone are great to stop the cravings, but I want to give people an opportunity to face their demons and to understand why they turn to that altered state in the first place,” the York County Sheriff told the Bangor Daily News.

Cost is a major reason, too. Medical care is already enormously expensive for jails and prisons, whose populations have disproportionately more health care needs.

Cumberland County Sheriff Kevin Joyce, who is not a doctor but presides over what he has called the state’s largest mental health and detox facility, has cited cost as an issue but also opposes MAT because he thinks jail stays are too brief to initiate rehabilitation.

With this in mind, painful and potentially deadly detox is a reasonable alternative to real medical care. In 2016, Sheriff Joyce estimated the jail provided detox and withdrawal services to around 30 inmates per week under medical supervision because “it is risky, they could die.”

It should therefore surprise no one that Suboxone (a sublingual film of buprenorphine and naloxone typically administered in MAT) is one of the most common contraband items found in Maine’s jails and prisons.

Authorities created this lucrative and dangerous black market through their prohibition on MAT. Corrections officers exploit inmates in this market for their own financial gain. Incarcerated people desperately trying to avoid withdrawal are made to pay high prices at substantial risk to self-medicate.

Meanwhile, officers are increasingly carrying the lifesaving overdose reversal drug Naloxone, even though MAT could prevent some of those overdoses from happening in the first place.

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