Warning: Detoxing in Jail May Lead to Severe Injury or Death

By Christopher Dale 07/18/19

Given the undeniable and inextricable link between jails and dangerous withdrawal from drugs and alcohol, isn’t it time that more jails had adequate detox infrastructure and medical personnel?

male inmate holding cell bars, detoxing in jail
Over 65% of people serving sentences in jail meet the medical criteria for substance addiction or abuse. © motortion | Dreamstime.com"

In January, Frederick Adami was detained in Bucks County Correctional Facility in Doylestown, Pennsylvania. Soon, he began vomiting and defecating profusely and persistently. His cellmate’s pleas for medical assistance were ignored for hours. The next morning, guards found Adami dead in his cell. The cause of death was opioid withdrawal – a condition that, when properly medically supervised, has a near-zero mortality rate.

In March, an inmate in a Delaware County, Ohio jail died from opioid withdrawal despite being on the facility’s medical addiction protocol. A sheriff’s office spokeswoman felt “pretty confident that there were no red flags ... that there was nothing more that we could have done.” In nearby Logan County, a pending lawsuit charges that an inmate died last June after being strapped to a chair while withdrawing from alcohol — a drug whose legality belies the grave risks of nonclinical detoxing, including seizures and the substance-specific delirium tremens.

Hard Facts and Half-Measures

The story of withdrawal oversight in our nation’s jails is one of convincing facts met with half-measures. According to an instructive paper published by the Center for Health & Justice titled “Safe Withdrawal in Jail Settings,” 64,000 Americans died from drugs in 2016 (the number climbed to 72,000 in 2017), and 20.1 million people reported substance abuse issues in 2016.

The paper then cites a truly eye-opening statistic: nearly two-thirds of people serving sentences in jail meet the diagnostic criteria for drug dependence or abuse. Incredibly, that data is from 2007-2009 – before the current opioid crisis and its record addiction and death totals. And since these detained people with addictions to alcohol or drugs are separated from their substances by metal bars, jails are often ground zero for withdrawal symptoms to both begin and worsen.

Alarmingly, these hard facts are followed by soft recommendations. The paper concludes that “medically supervised withdrawal from alcohol or illicit substances is ideal whenever possible,” and that “partnerships with local medical providers can help jails safely manage withdrawal syndrome.”

“Ideal whenever possible” is official-ese for “if it’s convenient for you” and especially “if you can afford it.” And “partnerships with local medical providers” is an intentionally vague phrase providing more cover for jails than coverage for the jailed.

Wardens Are Not Equipped to Treat Withdrawal

Isn’t it the duty of law enforcement officials to prevent unnecessary injuries and deaths in their own jails? High, drunk, or sober, shouldn't concern for inmate safety be a priority? What’s more, as withdrawal tends to occur early in the detention process, it undoubtedly affects many detainees who haven’t even seen a judge yet, much less been convicted of a crime.

Given the undeniable and inextricable link between jails and dangerous withdrawal from drugs and alcohol, isn’t it time that far more jails had adequate detox infrastructure and medical personnel?

The issue clearly isn’t getting the attention it deserves. New York City — a historically forward-thinking city whose mayor, Bill de Blasio, is among the country’s most progressive — is a prime example, since its jail system has been a focal point of change in recent years.

New York plans to replace its notoriously decrepit jail at Rikers Island with a number of smaller jails spread throughout the city. Despite improved safety being a key tenet of the long overdue initiative, the word “withdrawal” can be found exactly zero times in its 50-page roadmap plan

Granted, the plan does include a program called HealingNYC, which treats opioid-dependent inmates with methadone, a known treatment for weaning. However, merely distributing meds won't matter if an inmate shows the types of severe symptoms — including relentless vomiting and defecating — that can lead to long-term health issues or death. Further, methadone won’t do a thing for those withdrawing from alcohol.

Though no national record is available detailing withdrawal deaths in jails, the scenario is far from far-fetched: according to HealingNYC, 17 percent of the 55,000 people admitted annually to NYC's jails are in acute opioid withdrawal. Investigative reporting by Mother Jones found 20 lawsuits filed between 2014 and 2016 alleging that an inmate died from opiate withdrawal complications — a figure that, according to an attorney for one of the victims, likely represents a mere fraction of the actual total.

And neither figure includes people going through alcohol withdrawal, a condition with even more dangerous complications. 

These situations call for medical personnel, not just medicines. As a larger report on our jail system's healthcare crisis in The New Yorker noted, "withdrawal can require close monitoring and specialized treatment that jail wardens are not equipped to provide."

Healthcare Behind Bars: Profits Over People

And while many local jail systems have turned to private entities to provide healthcare for inmates, unsurprising reports have surfaced that many of these organizations place profits over people, and tend to operate only as effectively as they are overseen. In Arizona, which employs a private healthcare provider called Corizon, a pending lawsuit accuses the state of care so shoddy that it violates the Constitution's Eighth Amendment ban on cruel and unusual punishment.

As a recovering alcoholic, I’ve both heard and witnessed frightening accounts of alcoholics and addicts detoxing without medical assistance. Too many of these stories unfolded in jails following recent arrests; in 2011, my final drinking spree ended with 30 hours in a lower Manhattan jail following a DUI. Fortunately my withdrawal symptoms were minor, but I have no confidence in the ability of that antiquated facility — so dank and dungeon-esque it earned the nickname “The Tombs” — to handle serious withdrawal.

Nobody is expecting perfection. Compared with larger, more concentrated state and federal prisons, jails are inherently scattered, transitional facilities operated by county or municipal law enforcement departments. With more than 3,000 jails across the country housing some 700,000 detainees, it's unrealistic to mandate each be fully staffed and equipped to treat all facets of drug and alcohol withdrawal.

However, we can and should do far better. Amid recent encouraging changes in the way the criminal justice system treats drug-related offenses — reduced sentencing, increased redirection and referrals to rehabs, equipping police officers with the fast-acting opioid overdose-preventing drug naloxone — it only makes sense to improve the way we deal with addiction and alcoholism at a detainee's first true danger point. Increased funding for proper detox facilities and trained medical personnel at jails should be considered another stepping stone in an ongoing fight to reduce drug- and alcohol-related injuries and deaths.

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Christopher Dale is a recovering alcoholic and freelance writer who frequently covers sobriety, parenting and politics. His work has appeared in Salon, The Daily Beast, New York Newsday and Parents.com, among other outlets. Follow him on Twitter at @ChrisDaleWriter.