Jul 11, 2016 | By Nadia Sheikh

Death Without Detox: Opiate & Opioid Withdrawal in U.S. Jails

Addiction & Recovery News Addiction Resources Drug and Alcohol Detoxification Heroin Heroin Addiction Painkiller Addiction

The U.S. Heroin Epidemic

We hear stories on the news daily about the nation’s heroin epidemic. There are countless stories of people, from all socio-economic and demographic groups, dying from heroin or opioid overdoses—more than the number of people dying in motor vehicle crashes each year.

More and more celebrities are getting publicity for their struggles with drugs, or their decision to check into rehab. Even policymakers and our own President have called for action to address the opioid epidemic. As a person in the recovery community, I meet so many young people—teenagers even—who are trying to claw their way out of heroin addiction.

On June 23^rd of this year, the UN Office on Drugs and Crime released its World Drug Report for 2016, examining the health impact of the different substances of abuse around the world. This report found that heroin is currently the deadliest drug worldwide. In the U.S., as of 2014, there were about one million heroin users—three times the number in 2003. Most concerning is the rise in the number heroin-related deaths, which is five times as many since 2000.

In a report with CBS News, addiction expert Scott Krakower gave a statement discussing the nation’s crackdown on prescription painkillers, explaining that, “prescription drugs, like Vicodin and OxyContin, were being overprescribed and as prescribers slowed down the prescriptions of these drugs, heroin use went up.”

Unlike these prescription opiates and opioids, heroin is an illegal drug that can lead to a user’s arrest or incarceration. The UN report also discussed the problem of heroin abuse in prisons, and the need for alternative measures to help these people besides conviction or incarceration. Heroin has caused increasing problems all over the U.S., but death from withdrawal has been an emerging problem in jails as heroin, opiate, and opioid abusers are separated from their drugs without medical detoxification.

The Preventable Death of a Teenager

Most recently, CBS released a report this week about the death of 18-year-old Victoria “Tori” Herr while she was in jail at Lebanon County Correctional Facility in central Pennsylvania. This way Herr’s first arrest on heroin charges. Herr had just graduated from high school in 2014, despite using heroin during the last few months of school, and was a talented artist.

On the day before her arrest, Herr’s mother Stephanie Moyer met with her daughter to discuss an inpatient treatment program for Tori. Although Tori was arrested before she and her mother could set up a stay in rehab, her mother thought jail could was at least a safe place for Tori until she could get into a treatment facility.

During her intake, Tori told officers she’s been using 10 bags of heroin a day. Three days after her arrest, Tori made a disoriented call home to her mom from jail. During the call, she begged for a drink, some lemonade, but the staff at the facility wouldn’t give her any. Her mother asked what was wrong and Tori replied, “I don’t know, but I’m seeing people die. I’m going to die.”

Tori’s mother knew that her daughter was in withdrawal. On her last night in jail, Tori was staggering when she was taken to the medical unit. They gave her water and Ensure, but returned to her cell only to continue vomiting. Constant vomiting poses a host of health risks on its own, including delirium, electrolyte imbalance, and cardiac damage.

But Tori also went some time without oxygen, causing irreversible brain damage, after she collapsed in her cell. She was taken to a hospital and put on life support, but Tori never regained consciousness and was taken off of the support 5 days later. Although there are well-established medical treatments for heroin withdrawal that save so many lives, Tori didn’t have access to these resources.

In response to Moyer’s lawsuit for her daughter’s death, Warden Robert Karnes said that his staff followed “all operational protocols” in treating Tori

The Recent Death Toll

In the past two years, CBS News reports at least a half-dozen withdrawal-related deaths in jails across the nation. Here are a few of their stories:

In 2014, 26-year-old Madeline Pitkin was an inmate at an Oregon jail. She wrote pressing notes to the jail staff—multiple times—calling for help. She wrote: “I haven’t been able to keep food, liquids, meds down in six days…I feel like I am very close to death. Can’t hear, seeing lights, hearing voices. Please help me.” Jail staff observed Pitkin growing weaker, vomiting, and even defecating in her own pants. Though the jail’s medical reports indicated that Pitkin was given medication, she was found unresponsive and pronounced dead in her cell within days. The autopsy showed no controlled substances or medicine in her system at the time of death.

In 2014 in a Detroit-area jail, 32-year-old David Stojcevski was arrested for careless driving and sentenced to 30 days instead of paying a $774 fine. During his stay, Stojcevski was withdrawing from methadone, opioids, and benzodiazepine. After 16 days, he had lost 50 pounds and was suffering an “excruciatingly painful and slow” withdrawal, according to his family. In a video from jail surveillance, he can be seen lying naked on his cell’s stone floor while he died. Similarly, the facility claims the staff did what was legally required of them.

In 2015, 25-year-old Tyler Tabor was put into a Colorado jail facility with two misdemeanor arrest warrants. Tabor was a father with a young son, as well as an opiate addict who was also taking a prescribed benzodiazepine, Xanax. He told a nurse about these substances he had been taking, but wasn’t given any detox medications—only Gatorade. Tabor was vomiting, had diarrhea, and had violent muscle spasms while seeing a nurse. When he begged for an IV, the nurse told him IVs were only given when “absolutely necessary. He was found on his cell floor, struggling to breathe, and pronounced dead only 6 hours after his plea for an IV.

The Current Problem in Jails

Deaths from opiate and opioid withdrawals are extremely dangerous, which is why most people who abuse these drugs attend a medical detoxification or drug treatment facility. Opioid withdrawal can be physically terrible and uncomfortable, with restlessness, aching bones, cold sweats, vomiting, and diarrhea. However, withdrawal is rarely life-threatening with the aid of proper medication, monitoring, and intravenous fluids if needed.

Each jail or prison has different “operational protocols” to follow when treating a person struggling with addiction, and they each have access to different resources—some more limited than others. The Philadelphia Prison System screens inmates using the Clinical Opiate Withdrawal Scale to determine the need for medication or IV fluids. At Rikers Island in New York, inmates can also receive methadone maintenance treatment.

However, in different areas of the country, especially in smaller jails, there can be lacking in-house medical care and monitoring. Emma Freudenberger, a civil rights lawyer, told CBS that jails have a duty to care for their inmates. She has witnessed the growing problem of heroin addiction in the country, and she believes that the lack of proper care may come from a general lack of concern for people who struggle with addiction.

Jails may never offer total rehabilitation programs with the kind of comprehensive care many families seek in inpatient rehabs, like Tori Herr’s mother. Yet, Freudenberger is adamant that jails can be doing more to ensure the basic human right to life for inmates and addicts. Whether Lebanon County Correctional Facility had the proper resources to treat Tori Herr or not, Freudenberger maintains, “they had to do everything they could to keep her alive. If they couldn’t do that, they had to send her somewhere else. They couldn’t just let her die.”