ACLU Sues to Allow MAT During Incarceration




I was sent a link to this article that made my day:

This article reports that the ACLU (American Civil Liberties Union) has taken the case of a man in recovery on medication-assisted treatment who must serve a nine-month jail sentence starting in September in Maine. This man, Zachary Smith, has been in recovery on a buprenorphine product for the past five years. Ordinarily, the jail has a policy of NOT continuing medication-assisted treatment to inmates, leading to forced withdrawal from these medications.

Opioid withdrawal doesn’t (usually) kill healthy adults but can be fatal to people in fragile health. Acute withdrawal does cause significant suffering, and it leaves the person at increased risk of death from overdose upon release from incarceration.

The ACLU says there are two reasons why denying this medical care is against the law. First, denying medical treatment to inmates violates our 8th amendment against cruel and unusual punishment. Second, the Americans With Disabilities Act recognizes opioid use disorder as an illness covered by that Act. This means denying appropriate medical treatment for this condition is discrimination.

The ACLU filed a preliminary injunction to speed up a hearing of the case prior to the beginning of the jail sentence. This means the case will be heard – hopefully – before Mr. Smith must show up for his sentence in early September.

I was so happy to see this case. I think it could be a watershed moment for this nation, one way or the other. I have never understood how it could be legal for a person to be denied medical care while incarcerated, yet it happens across this country every day. In most jails, patients in treatment for opioid use disorder with medication-assisted treatment are denied their medication.

I’ve blogged about this before. I’ve even called the NC chapter of the ACLU myself, many years ago, to ask for help, but was told I had no standing, and that it needed to be the patient to contact the ACLU for help. But my patients sentenced to jail are often reluctant to bring an action against their local jail, feeling they might receive retribution of some sort – a very realistic concern, at least in my area.

Can you imagine the uproar if any other group of patients with chronic illness were denied medical treatment? What if patients with heart disease were denied life-sustaining medications during incarceration? What if diabetics were denied their insulin? For all I know, this may be happening. If it is, citizens of this country should not stand for this. We shouldn’t stand for it for people with substance use disorders, either.

Since all of this is happening in Maine, I was curious if North Carolina has any similar cases pending. I went to the website of the North Carolina chapter of the ACLU and found nothing advocating for inmates to be continued on medication-assisted treatment for opioid use disorder.

However, I did find that our state chapter of the ACLU filed a federal class action lawsuit against North Carolina’s Department of Public Safety’s policy of denying treatment for Hepatitis C to incarcerated people with the virus. The current class action suit was filed on behalf of all people incarcerated in NC with Hepatitis C.

Current expert recommendations are that all incarcerated people receive Hep C testing, since according to data from the Center for Disease Control, around one-third of all prisoners are infected with Hepatitis C.

In the past, recommendations were to wait until the person with the Hep C virus developed liver damage before treating. Those expert recommendations have changed. The current recommendation is that all people with active Hep C infection should be treated. Experts now also recommend treatment even if the patient has not stopped illicit drug use.

The NC Department of Public Safety’s present policy is that incarcerated people with Hep C infection that’s caught early, when at its most treatable, are forbidden to receive treatment while incarcerated.

This article says there’s no law for universal testing of prisoners for Hep C, and the decision to test is left up to personnel at each jail site.

Both issues are important, though to me, continuing access to medication-assisted treatment appears more pressing, and could prevent more deaths in the short term.

I will follow these cases, and give updates to my readers.



12 responses to this post.

  1. Posted by Cheryl Kupras on August 12, 2018 at 11:54 pm



  2. Excellent. As a person that came off of methadone while in jail and came off of buprenorphine outside of proper titration I am intimate with the suffering and have been advocating and hoping for this type of reform. Great day in North Carolina minimally for them recognizing that this is a civil right. The jails and prisons main concern is diversion of said medication..narcotic. however , this is not the same as receiving a Trazodone that you can flip to another inmate for three or four items. There are going to be very few people that are going to give up this medication because nobody wants to go into withdrawal. However just in case implement a couple extra steps and you can eliminate the diversion.


  3. Thank you Dr. Burson. Every time I’ve had a friend incarcerated they have suffered. Terribly. One of them passed away.

    I’m not as young anymore and only know one person I worry about so much.

    You’re right, this could be a big deal. Recognizing we are actual humans that could die if in frail health and our meds ripped off our receptor sites…

    One day maybe all these old, white men will get it that we’re all one. The planet is not just a big dirt clod, she’s alive with a soul. We’re all connected. If you hurt. I hurt. It seems these in these times it’s more “I got mine, to hell with you.”


  4. This is awesome! My old clinic was working to provide MAT to the jails. They’ve been open to it here in VA (some), but there is no regulation in place to support it when it came to the DEA and State…and what they can’t see they don’t understand. I do believe it’s worth getting everyone on board and devising a procedure to get current MAT facilities involved if the jail doesn’t want to provide the structure for it.

    Thanks for sharing!


  5. Posted by Mary Anne Hughes on August 13, 2018 at 12:28 pm

    Wow! That is great news! Having worked in the prison and jail system as a volunteer and as an NP, I always saw this as a serious deficit. I hope in our collective work towards destigmatization, they’ll finally address this in my lifetime. Thanks for always giving a voice to the voiceless, Jana, and keeping us all in the loop about these important issues. You are a treasure to all of us working in the field and to all our patients too!


  6. Posted by Scott on August 17, 2018 at 1:23 am

    I don’t know how they’ve gotten away with this for so long to be honest.

    I feel like a large section of the US public and law enforcement have this view of MAT as being some Government service where junkies go to get shot up with party drugs or something (I hate to generalise and may be wrong about this, but so many of the stories I read from people on MAT in the USA have helped me form this view, such as police waiting outside clinics to bust patients, or people getting charged with DUI for having Suboxone in their car).

    Looking at it through this lens, I can see why they’d want to “remove this freedom” when incarcerating someone.

    I find it interesting (but not surprising) how quickly their views change when one of their loved ones is afflicted with opiate addiction.

    If these inaccurate and dangerous views are allowed to continue then it won’t be long before every American has a loved one addicted to opiates. Maybe that’s what it will take for the tide to turn.

    I sure hope this guy wins. Withdrawing bupe (or methadone) to someone else’s schedule is a sure fire way to light the embers of a relapse. Doing it without any comfort meds on the floor of a jail cell is what I would call a form of torture.

    I’m angry just thinking and writing about this.


  7. They wouldn’t dare do this if they could feel 1/4 of the agony of withdrawal! Amazing how anyone could watch this without having any empathy at all. Something this world seems to have a huge shortage of.


  8. Posted by Scott on September 3, 2018 at 9:02 pm

    ……and….. it’s happened again. Even after they found her unresponsive they didn’t bother to call for medical assistance. They just left her dead in the cell until next morning:


    • Outrageous, sickening! What a waste! THIS MUST STOP!
      How bad it is when rigor mortis has time to set in before she gets attention!


      • Posted by shelbypolis on January 19, 2019 at 7:38 am

        Hey I’m very new on WordPress and I’m socially inept- is there a way to privately message a person if you’d like to ask them for their badly needed assistance? Like- for example, if Lifeline7414 @ g mail . com was relavent info..? How would I send it to the intended person? Or is this strictly a public display sorta deal?? Hmm.. ANYONE awake??

  9. Posted by shelbypolis on January 19, 2019 at 7:34 am

    That’s terrible. I guess there are people who receive really, REALLY substandard care. Wonder how long I’ll lay around my place before found?? Oh well I got cable.
    Seriously- I think inmates probably get worse care than even heroin addicts get. Which is pretty damn bad, could be bias tho..😘


  10. Good new! Inmates are put in the situation of undergoing acute withdrawal symptoms or trying to buy medicine on the black market.


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