Brenda Smith has been treating her substance use disorder with medication for the last decade.

She has tried in the past to taper off the medication, buprenorphine, but has not had success. So she keeps taking it, at her doctor’s suggestion. The medication makes her feel normal and allows her to care for her children, she said.

She hasn’t had a relapse in five years.

But Smith soon must report to the Aroostook County Jail for 40 days to settle a theft conviction from last year. While there, she won’t be able to take buprenorphine because the jail prohibits it. She worries what that could mean for her long-term recovery.

“I don’t want to lose everything I’ve worked so hard to achieve,” Smith said Monday during testimony in U.S. District Court in Portland.

The 35-year-old Madawaska woman is suing Aroostook County, as well as Sheriff Shawn Gillen, for denying her medical care, arguing that doing so violates both the Eighth Amendment to the U.S. Constitution, which prohibits cruel and unusual punishment, and the Americans with Disabilities Act.

Her trial began Monday and is expected to last at least three days.

After opening statements from one of her attorneys, Emma Bond with the American Civil Liberties Union of Maine, and Aroostook County’s defense counsel, Peter Marchesi of Waterville, Smith was called as the first witness.

She talked about her struggles with opioids, which began when she was a teenager. She said her addiction led to her being homeless for a time and separated from her children. She’s worked hard to rebuild her life, she said, and being in a medication-assisted treatment program has been a major part of that.

“It makes me feel normal, like before I started using drugs,” she said.

Smith was asked by one of her attorneys, James Monteleone, if she worried about relapsing or even overdosing if she had to go 40 days without her medication.

“Absolutely,” she said.

Smith said she’s had to go without medication only once before, for seven days while she was in the York County Jail. She said the experience was brutal. She even contemplated suicide.

The ACLU of Maine said most of Maine’s county jails have some sort of prohibition on medication-assisted treatment, although the conversation around that has started to shift as the opioid crisis has worsened. Some, including the York County Jail, have recently begun to implement medication-assisted treatment, which is widely regarded in the medical community as the gold standard for those seeking to overcome opioid addiction.

But for jail officials, there is a risk that the medication could be diverted and trafficked within the facility. Marchesi talked about instances where inmates will take their medication in front of a guard and then make themselves vomit later to preserve the pill.

Marchesi used his cross examination to probe for inconsistencies in Smith’s story and also to get her to admit that she understands the risk of going 40 days without medication and would handle that appropriately given what she has to lose.

After Smith stepped down, her attorneys called as an expert witness Dr. Ross MacDonald, a New York City internist who oversees clinical care in the jail system there, including medication-assisted treatment.

MacDonald testified that during his time overseeing MAT in the jails there, the number of people enrolled tripled. He also said there is a body of research that shows inmates who are not able to access medication-assisted treatment while incarcerated are at a far greater risk for overdose once they get out.

Asked if Smith faced similar risks, MacDonald said yes.

“Even if the risk of death is low, we would take it very seriously,” he said.

Smith’s attorneys plan to call several other medical experts as the trial progresses, according to documents filed with the court.

Smith filed her lawsuit in September, shortly before she was to start her jail sentence. That sentence has been stayed until April to allow for a resolution in her civil case.

The lawsuit comes at a time when more emphasis has been placed on improving substance use disorder treatment in jails and prison.

Maine Gov. Janet Mills signed an executive order last week directing her administration to take a series of immediate steps to address Maine’s opioid crisis. Among them were asking her corrections department to explore ways to expand medication-assisted treatment in state prisons. County jails, however, are not governed by the state.

Although Smith’s case is not a class action, ACLU officials said it could serve as a precedent for future cases.

A similar lawsuit was brought in Massachusetts. In November, a judge there ordered a local jail to immediately provide methadone to a man recovering from opioid addiction.

Eric Russell can be contacted at 791-6344 or at:

erussell@pressherald.com

Twitter: PPHEricRussell

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