An Aroostook County man facing nine months in prison got some good news in court last week. It won’t reduce his sentence, but it could save his life.

Zachary Smith of Caribou, who is in treatment for opioid use disorder, sued the Maine Department of Corrections in August, challenging the state’s policy of denying prisoners access to addiction medication. In a humane and farsighted settlement, Smith agreed to drop his lawsuit, and the state agreed to maintain his doctor-prescribed medicine while he is an inmate at the Maine Correctional Center in Windham.

The agreement reflects the best thinking on how to fight the overdose epidemic and help people turn their lives around.

The opioid epidemic is a public health crisis in which law enforcement is as much on the front lines as doctors and hospitals are.

Trafficking in street drugs like heroin or pharmaceutical pain pills is illegal, so it’s no surprise that people with drug problems end up on the wrong side of the law. Drugs are expensive, so users have been known to commit robbery and theft to raise cash.

When people with opioid use disorders end up in prison or jail, they have an opportunity to change their lives for the better, but outdated policies stand in the way.


Medication-assisted treatment is the standard of care on the outside, but it is forbidden in most correctional settings. Even people who were under treatment before going to jail are forced to survive painful withdrawal and become much likelier to overdose as soon as they get out.

Smith had a long struggle with opioid use, along with other co-occurring mental illnesses (a common combination, according to doctors in the field). For five years, he was able to keep his compulsion to use opioids in check with the prescribed medication Suboxone. The drug does not intoxicate him, but it prevents withdrawal and controls cravings, allowing him to live more productively.

He pleaded guilty to assault after a confrontation with his father, and he was sentenced to prison, during which time he would have to stop taking his medication.

This would have been painful, maybe even deadly.

Withdrawal symptoms include anxiety, muscle cramps, nausea, diarrhea and can last hours or weeks. But once the symptoms pass, the patient isn’t “cured.”

Opioid use disorder is a brain disease, one that manifests itself through the compulsive hunger for more drugs, cravings that can last for life. Even if inmates are forced to abstain from drug use while incarcerated, they are at a high risk of relapsing when they get out. That can prove fatal, because the former inmate will have a low tolerance and can easily overdose.

For now, the settlement affects only Smith, but it gives the Department of Corrections a chance to develop protocols to safely administer the drug and make sure it doesn’t get trafficked in the prison.

Based on the experience elsewhere, the state should grab the opportunity to fight the opioid crisis everywhere it can.

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