WINDHAM — In prison, there is no methadone, no Suboxone, no one to give an opiate addict going through withdrawal symptoms words of comfort or even a warm blanket.
It's cold, so cold that an addict's skin erupts into goose bumps like those on a plucked turkey.
It's the jail plan. You get through opiate withdrawal cold turkey.
"It’s bad; you get cramped legs," said 26-year-old Tanya Cahill of Lewiston.
Cahill is serving time in the Maine Correctional Center in Windham for burglary and aggravated assault in a 2008 home invasion in Lewiston.
"You can’t stop moving," she said. "You can’t sleep."
She shares the facility with 115 female prisoners. Of those, 79 are there for substance-abuse-related offenses, said Amanda Woolford, manager of the women's unit.
Cahill has served time in state prison and county jail, on and off for more than 10 years. She knows what it's like to go through withdrawal behind bars.
Her criminal convictions range from a misdemeanor driving without a license charge to felony aggravated assault, when she repeatedly hit a man over the head with a baseball bat in retaliation for stolen items.
Most opiate-addicted inmates in Maine go through withdrawal in county jail, where they are held for court dates, before they reach prison, Cahill said.
"Me, personally? I cried a lot. It took almost three weeks for the withdrawing," Cahill said, recalling how she was forced to withdraw from an addiction to oxycodone with nothing but medication to keep her blood pressure from skyrocketing.
Exceptions to cold turkey withdrawal are sometimes made, such as for women who enter the prison system pregnant, Woolford said.
"Sometimes we do get women who are still detoxing because of the extent of their use," she said. "Medical would make a determination on the fetus' health and whether continued opiate treatment was in the best interest of the child."
According to the National Institute on Drug Abuse, an estimated 200,000 addicts pass through the nation's criminal justice system each year, but as few as 2,000 receive opiate replacement therapy while imprisoned.
A 2011 NIDA nationwide survey of prison medical directors showed they do not offer opiate replacement therapy for a number of reasons, including doubt about the benefits of the medications, cost, concerns about the security of supplies and longstanding institutional policies.
The Maine Department of Corrections, which operates six adult prisons and two youth facilities, provides substance-abuse treatment before inmates leave the system.
"We offer (Differential Substance Abuse Treatment), an intense, 18-week treatment program that meets for three hours, three times a week," said Woolford, who took over the Women's Center last August.
"We also have Seeking Safety, which connects substance abuse with past trauma," she said. "We also offer Alcoholics Anonymous and Narcotics Anonymous programs, and one-on-one treatment when needed."
Tanya was 11 or 12 years old, a student at Lewiston Middle School, when she began smoking marijuana and experimenting with pain pills. She was prescribed opiates for a back injury when she was 12, after falling and suffering three slipped discs.
By the age of 14, she was addicted to opiates. By the time she was 15, she had left school and was buying any opiate she could find, including Percocet and Valium. "Anything that was out there," she said.
It was easy to score, she said. "You just walk outside, really."
For Tanya, the high felt good.
"It was something new," she said. "It took away not only my pain, but my stress, my anger. It took away all my feelings. I didn't feel for anything and I liked it. I didn't have to feel for anything."
It was at that time that she first entered "the system," after assaulting someone for no particular reason.
"I felt like hitting somebody at the time," she said. She was sentenced to the Maine Youth Center for a weekend.
Tanya has had anger problems for years.
"I would just lash out," she said. "I started drinking and I lashed out a lot. It was a combination of drugs and drinking."
"There were times when I wish someone was just there I could talk to, and there never was," she said.
By the time she was 22, she had been involved in several crimes.
Now she lives in a tiny, two-bed cement cell right off the large day room where many inmates spend their time talking, reading or just hanging out under the watchful eyes of guards.
Her metal-frame bed is covered by a pretty red and white crocheted blanket with her name on it that was stitched by another inmate. A small shelf is filled with books and pictures of friends and siblings on the white-painted cement walls. Her view from the one small window is rolls of barbed wire.
She is allowed to buy a television and PlayStation but has no access to the Internet. Most of her days are spent working long hours in the kitchen, cooking for other female inmates.
An articulate woman, Cahill is adamant that a methadone maintenance-based drug treatment program provided by clinics, or a doctor’s prescription to Suboxone, is not the answer to getting clean from an opiate addiction.
"If your mind, body and soul are actually into getting clean, then there is no reason that you should be on methadone or Suboxone for two years," she said.
"Me, personally, it took me a little over a month to get clean," she said. "That's not saying I didn't relapse or I still don't have cravings. I do. That's something I'll always have — that craving."
Her case worker, Melissa Meymaris, said Cahill, like many others, will probably have to undergo substance-abuse treatment before she leaves prison, as part of her release program.
"As it gets closer to her release date, everybody in the facility is screened for whether or not they need substance abuse treatment, and if it's deemed appropriate, then they have to before they get released," Meymaris said.
Cahill hopes for a better future. This summer, once released, she wants to go to Connecticut where she will live with her father and help her uncle in his construction business. Long term, she hopes to volunteer at a teen center to act as a support for other young women who might be heading down the wrong road.
"I want something better for myself," Cahill said. "I used to be a strong woman and I lost that somewhere and I need to find it. It’s there somewhere and I need to find it."