Addicts in jail: Withdrawals Take Inmates to a Dark Place

APPLETON, WISCONSIN – Natalie Coenen spent her first night in jail staring at a wall. She couldn’t stop shaking.

She had been addicted to heroin for years, but had never been locked up. That changed on May 12, 2013, when Coenen, then 19 years old, found herself in the Outagamie County Jail.

She spent the night in a daze. Her drugs hadn’t worn off entirely, but she was already starting to feel sick.

“It was scary and really bright,” she said. “They always keep the lights on.”

She was released the next day after paying a few hundred dollars for bail. Her parents asked to take her out to eat. Coenen made an excuse to leave and got high instead.

“I couldn’t even wait through dinner,” she said.

She began to lose control of her life. A year later, Coenen was back in jail for at least the fourth time since her first arrest. Her parents refused to bail her out.

The symptoms of opioid withdrawal hit her hard. She couldn’t eat or sleep. Her muscles ached. The cravings were intense. She couldn’t stop sweating or throwing up. She could barely curl up on the cold cement floor in the jail.

“You can’t sit still, but you can’t lay down,” she said. “You can’t stand up. You can’t do anything.”

Coenen called her parents every day. She begged them for help. She threatened to kill herself — and thought about doing it.

“The pain is so real and so intense at that moment,” Coenen said.

She didn’t see a way out.

The jail didn’t have much help to offer, Coenen said. She was given Benadryl — a medication typically used to treat allergies — and told to drink water. It didn’t help.

Her father couldn’t take it anymore and, after about a week, bailed her out. She began getting treatment with suboxone, a medication often prescribed to help with opioid addiction. But she relapsed and was sent back to jail, where she went through withdrawal all over again.

Her experience isn’t unusual. Hundreds of inmates have gone through opioid withdrawal in the Outagamie County Jail in the last five years. The experience is difficult for addicts to endure anywhere, but can be excruciating for those who find themselves behind bars, where resources are often limited.

The number of times inmates have gone through opioid withdrawal at the jail rapidly increased from 25 in 2013 to 460 in 2017, according to Correct Care Solutions, the company that provides medical care for inmates at the jail. This year, the total had already reached 316 by early August.

The trend in Outagamie County isn’t out of the ordinary. The opioid epidemic has continued to put a strain on jails and prisons across the country, said Judd Bazzel, a doctor and clinical patient safety director for Correct Care Solutions, which serves 25 jails in Wisconsin and more across the country..

“It certainly is becoming more and more common,” he said.

Coenen, now 24, was barely a teenager the first time she tried heroin. She was hooked from the start.

“The first time I used it I said I would never love anything more,” she said.

The drug took over her life, but things didn’t fall apart right away. Coenen graduated with honors from Xavier High School in Appleton despite frequently missing class, but she couldn’t hold a job after getting out of school.

“I put myself in dangerous positions, met horrible people and got involved in some bad relationships,” she said.

She was injecting heroin and taking oxycodone several times a day when she went to jail for the first time. She couldn’t stop, even after going through withdrawal in jail several times.

Coenen wasn’t entirely sober in jail, either. Other inmates could sometimes get her drugs, such as Adderall or Xanax. She took whatever she could get.

The more opioids a person uses, the higher a tolerance they develop, according to Eric Smiltneek, a doctor at ThedaCare Physicians in Oshkosh. And a higher tolerance means a more severe withdrawal.

The current situation at the jail isn’t necessarily a health risk for addicts, but could increase the risk of a relapse after they’re released, especially if they’re still going through withdrawal, Smiltneek said.

Coenen was once released from jail after serving a four-month sentence and was supposed to go to treatment. She wasn’t able to get in for more than a week. She didn’t make it more than 12 hours without a relapse.

Coenen said she wanted to do better but simply couldn’t. She said the suffering she had just endured from withdrawal faded from memory in an instant and was replaced with an urge to use again.

“You would think people would make better decisions,” she said. “Sadly, it’s not that easy.”

The withdrawal from opioids doesn’t typically require a hospital stay. That means many addicts end up in jails, which weren’t designed to handle that type of problem, Smiltneek said.

“That’s putting a lot on jails,” he said.

The Outagamie County Jail has a single nurse working on each shift, along with a nursing director who works during the day, according to Correct Care Solutions. The jail has 556 beds and had 6,418 bookings in 2017, a small increase from the year before, according to last year’s annual report from the Outagamie County Sheriff’s Office.

The increasing number of inmates suffering from opioid withdrawal has had a direct impact on medical staffs at jails across the country, Bazzel said.

“We try to divide and conquer, for lack of a better word,” he said. “At a lot of our sites — the majority of our sites — we have built that into our staffing.”

Correct Care Solutions has an assessment specific to inmates expecting to experience opioid withdrawal meant to predict the severity of their symptoms, Bazzel said. The physical symptoms of opioid withdrawal are rarely fatal, but there are still risks that need to be monitored.

“People can die from dehydration,” he said. “That’s really what we’re trying to avoid.”

Many larger jails or prisons have nurses whose only job is to perform assessments on inmates expected to go through some type of withdrawal.

“That’s all they have time to do,” he said.

recent review of the medication procedure at the Outagamie County Jail by an independent expert found a number of issues, including problems recording and providing medication to inmates.

The report mentioned that inmates frequently arrive at the jail either intoxicated or going through withdrawal.

By: Chris Mueller

Published: September 12, 2018


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