Tuesday, June 14, 2011

2nd Gregg County death from Methadone withdrawal spurs calls for uniform policy on prescription drugs in jails

Another Gregg County Jail inmate has died after being denied prescribed Methadone - the second such case in six months - raising the question of whether policies on access to prescription drugs should be standardized, the TV station KYTX reported last week.
30-year-old Micah Garner's death is raising new questions about the county's drug policies.
Individual counties have the right to decide which medications are allowed inside their jails and counties around East Texas are handling that decision differently.

The Gregg County Sheriff's Department gave CBS 19 a copy of their drug policies. Medical workers inside the Gregg County Jail have two lists they're working from.

One of them lists drugs that can be administered to inmates. It includes things like allergy and cholesterol medications, even HIV treatments.

The other one contains 26 drugs banned from the jail. It's made up mostly of narcotics and other prescription drugs with the potential to affect an inmate's mood and motor skills.

Methadone, the drug both [Amy} Cowling and Garner were on, is specifically mentioned. The document also says detainees who enter with any of the drugs should have them confiscated.

In Smith County, they do it differently. Instead of a specific written drug policy, a doctor examines the inmate and makes an individual determination about what drugs are appropriate to give while they're in jail.

In Gregg County, a doctor does examine the inmates but is not allowed to go outside the list of approved medications. Sheriff Maxey Cerliano confirmed that list was drafted by a doctor, and not by the department itself.
Reporter Field  Sutton quoted an ER doc explaining that methadone "is typically prescribed for recovering drug users, such as heroin addicts. Sometimes it's also given to chronic pain patients." While withdrawal wouldn't normally lead to death, says the doctor, it can when it aggravates other health problems. Neighboring Harrison County (Marshall) also bans Methadone in the jail.

Sutton predicts the deaths may spur legislative action in 2013: "There's a growing movement to get state lawmakers to create a single policy for methadone inside jails and prisons. No bills have made it to the capitol addressing the issue, meaning it would have to be taken up in the next session."

MORE: See the original complaint of a lawsuit filed in federal district court by Amy Cowling's parents as a result of her death in the Gregg County Jail.

27 comments:

Prison Doc said...

Several facts should be pointed out here. First of all, methadone must be administered by a certified clinic or provider and it is a rare jail that meets this criterion. Continuing methadone administration isn't simple like continuing blood pressure medication or antidepressants. It's unlikely that a mid-sized jail would find it appropriate to qualify for this standard so I don't think one should be so quick to say that this is a deficiency of the Gregg county jail.

Second, as the quoted Emergency Department doctor points out, withdrawal of methadone is not commonly a lethal event. Admittedly the article does not SAY that methadone withdrawal caused the deaths, but the "post hoc, ergo propter hoc" idea is there.

Most methadone clients who enter jail do not have addiction as an isolated problem, and indeed most that I have encountered are using their methadone as a "side dish" to their main course of illegal narcotics. The only instance in which I've seen methadone continued in a jail, it was necessary for the jail to transport the patient to the methadone clinic for drug administration. The drug was not stored in, or administered by the jail.

These deaths are unfortunate but they do not appear to indicate that the involved jail has a lax standard of care.

Gritsforbreakfast said...

Actually PD, fwiw, two autopsies concluded that methadone withdrawal was the proximate cause of Amy Cowling's death. In that case, it's not just "post hoc, ergo propter hoc" but the determination of two different coroners. Further, in her case jailers were fired after falsifying records as part of a coverup. Certainly, the latter indicates a "lax standard," at the very least.

Prison Doc said...

As a matter of law, which I guess is what matters, the autopsy conclusion is a "fact". As a matter of medicine, the conclusion shows that she MAY have died from a seizure which MAY have been caused by Xanax withdrawal or MAY have been caused by opiate withdrawal. Or she MAY have died anyway.

An addict that died of her addiction. Not the jail's fault. God rest her soul.

Gritsforbreakfast said...

PD, she was arrested for traffic tickets on Christmas Eve and died because they wouldn't give her her prescription meds, before jailers falsified records to cover up what happened. I understand what you're saying about defining to a certainty what was the medical cause of her death, but to exonerate the jail and law enforcement under such circumstances - particularly when your conclusion differs from doctors who actually performed the autopsies - seems like a stretch.

Ted said...

As a recovering addict my self- one who, fortunately,did not have be on Methadone-I have never heard of anyone dying from methadone withdrwaal- PD's comments about Methadone being part of an addicts'"side dish" is simply an indication of his dearth of experience with a wide range of addicts-the two drugs, withdrawal from which regularly causes death,are alchohol and barbiturates, and could include xanax- step down withdrawal from Methadone is long, painful and messy,but this is my first encounter -in over 40 years of involvement with opiates- that I have heard of this phenomenen-methinks there are other drugs-or medical conditions-involved

zenith15 said...

OK look---first of all, this was NOT "step down withdrawal"--this was brutal cold turkey withdrawal with NO "step down". Methadone withdrawal takes weeks to complete safely due to it's long half life--not days--and these inmates were given nothing or next to nothing (an anti psychotic in Cowling's case, because she was "hollering" just before her death) to alleviate symptoms.

Second of all, these are not the only such cases. There were two deaths in the Orlando, Florida jail a few years back in close proximity to each other, involving young women on prescribed methadone treatment, both of whom were determined to have died from methadone withdrawals. There are also quite a few other cases I could cite scattered throughout the country. This does not happen in other, more civilized countries as every first world nation that offers MMT provides it in both their jails and prisons.

Protracted methadone withdrawal causes all the symptoms of opiate withdrawal--nausea, profuse vomiting, inability to retain fluids, horrible diarrhea, temperature and blood pressure fluctuations that may be extreme, chills, sweating, seizures, muscle twitching, etc.

This can be extremely dangerous particularly with methadone withdrawals because they often last weeks rather than days, and a person who might be able to tolerate this for a few days may NOT be able to tolerate such conditions for weeks on end, especially in a jail setting.And ESPECIALLY if they have other health conditions, which are common among recovering addicts, such as HIV, Hep C, etc or high blood pressure, liver disease, etc etc.

Even for those who are relatively healthy, protracted nausea and vomiting coupled with severe diarrhea, sweating, and no fluid replacement can lead to electrolyte imbalances that can cause cardiac arrest. Seizure activity is possible. Lastly, spiking blood pressure, left unchecked and untreated as is often the case in jails, can cause stroke.

All this for the cost of a few cents worth of a LEGALLY prescribed medication that is the most successful treatment method for opioid addiction available today--a common generic drug.

Any jail can apply for a license to dispense methadone if they don't want to take the inmate to the facility. Which is less expensive--obtaining said license, or the 5 million dollar lawsuit the Orlando jail had to pay to the families of the two dead women there? That jail captain now goes around lecturing to other jails about the dangers of withholding this medication and the new program they have to prevent this.

It is quite easy to prevent the medication from being diverted in a jail setting--observed dosing, plus isolating the inmate in an observed area for 30 minutes post-dose to insure it is ingested and absorbed--can prevent diversion completely.

These deaths have GOT to stop. This jail is absolutely responsible and I hope they sue the PANTS off of them. There is no doubt whatsoever that if Cowling had NOT been denied her methadone she would not have died 5 days after entry to the jail and to insinuate otherwise is appalling, inhumane and jaded in the extreme.

zenith15 said...

ANd no, Prison Doc, Cowling did NOT "die from her addiction". Her addiction was being successfully treated with MMT and had been for some time. She died from the abrupt cessation of both methadone and xanax, both prescribed to her for legitimate conditions,and both of whom it states clearly in the prescribing information should never be abruptly withdrawn. THAT is why she died.

Kim said...

I am a methadone clinic owner and director. It is common practice for our staff to bring methadone to incarcerated patients for a VERY minimal fee (which the patients pay). The smart prison docs and staff know how to avoid many serious problems by allowing this practice. This is simply BEST PRACTICE. It is evidence-based and overwhelmingly supported in the more reputable medical literature .

Maybe its just too simple.

zenith15 said...

One last thing:

Having a blanket policy prohibiting ANY type of mood altering medication, such as painkillers, sedatives, tranquilizers, etc. from being administered to ANY inmate for ANY reason is so inhumane it's sickening.

Any number of reasons could require such medications--cancer, severe chronic pain of certain types, musculoskeletal disorders, extreme panic attacks/anxiety that cannot otherwise be controlled, etc. Yes, each case should receive careful scrutiny as to medical history and need for said medication--but good lord, there are some cases in which it would be inhumane.

I find it pathetic that the jail treats horrifying diseases like the common cold and seasonal allergies, but refuses legitimately prescribed medication for a very serious, very legitimate medical condition, the abrupt withdrawal of which causes at the very least what amounts to excruciating torture and at the worst as we see here, seizures and death.

If we are going to use the rationale that they deserve no mercy for anything for the crime of being arrested, then why treat non fatal diseases like seasonal allergies and the common cold?

Cat said...

Isn't there a law against practicing medicine without a license? That's basically what the jails are doing when they make a determination that prescription medications 'are' or 'are not' given to an inmate.

Anonymous said...

If methadone was involved in the death of your loved one, please report it using link below. This is the only way we will ever get anything done. It doesn't matter how long it's been.
https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm

Anonymous said...

I have been to prison 3 times due to--I now realize-- self-medicating psychiatric disorders with illicit drugs. I have probably been to jail 6 or 8 times. I have been through maybe 15 different treatments for drug use.

Narcotics are my drug of choice and I have come off heroin/methadone in jail repeatedly, and also sedatives such as Xanax and Klonopin. Truth be told, I am lucky to be alive. I am now a few years clean and doing well, taking an effective combination of psych medications for depression and ADHD.

If a person is legally prescribed a medication, it, or an adequate substitute, should be provided, no questions asked, no excuses.

I'm talking to you Prison Doc...Such a draconian opinion is not only cruel and small-minded (What is wrong with you? I feel sorry for your wife, kids and dog; you are sick.), it is also irresponsible. Surely as a doctor you've had some training on statistics and efficacy and logical evaluation.

So I ask you: What are the statistics on continued abstinence following forced, cold-turkey withdrawal from a physical and psychological addiction like narcotics, sedatives, tranquilizers, or alcohol?
Now compare those to the statistics for methadone maintenance? You're talking like 2% vs 30%...We should offer to start people on MMT in jail when appropriate. And that's not even contemplating cruelty or liability.

I used drugs because I found life intolerable (and those feelings pre-dated drug use) and I ended up in jail and prison repeatedly for simply taking a substance into my body. Many will scoff but I view it as if there were laws criminalizing insulin for diabetics.

If I relapse and get arrested again I'll spend decades in prison...Not me, if push comes to shove I'm going down fighting. At that point I'd have nothing to lose, I'd get as much time for a drug offense as I would for doing what I had to do, if you know what I mean. And I resolved long ago that if I can't stand to live any more I'm taking as many sadistic bullies with me as I can...

It's safe to say society has a vested interest in my mental health and yet jerks like you, PD, defend institutional policies that are 60 years behind mainstream medicine and serve only to make things worse out of some sadistic sense of moral superiority.

There's an obscure piece of antiquated philosophy called the Hippocratic oath, you should read it some time.

eric said...

it just AMAZES me that people like this "prison doc" (surely to God whose only claim to being a real doc is that they stayed at a holiday inn) can be so incredibly heartless. "died from her addictions"?? what an idiot.
look, ive got NO patience for criminals, and 95% or more of jailbirds are just that. but taking someones medication away from them--ESPECIALLY in the case of a drug like methadone-- and forcing them into pain, depression, and all the other torture of withdrawals is just that--TORTURE.
arent we a better people and nation than that?

eric said...

omg! i have to retype the whole thing! haha

ok, first of all, it just blows my mind that someone like this "prison doc" (whose claim of being an actual doctor more than likely only stems from their staying at a holiday inn) can honestly mean what they are saying!
look, ive got zero patience for criminals, and 95% or more of jailbirds are. but to purposely withhold medications from ANYBODY--particularly when the result can be painful and possibly life-threatening-- amounts to nothing but torture. are we not a better people and a better nation than that?

eric said...

furthermore (and i apologize for the rant, but i feel strongly about this), i believe the problem here is ignorance. until a person has actually EXPERIENCED opiate withdrawals (and methadone withdrawals are the worst), they cant understand what theyre talking about.
the folks who make the rules are trying to do the right thing. so they go to some er doc and ask his advice: heres a news flash-- there are alot of doctors who dont know BEANS about methadone! just like the doc in the article. be obviously has no empathy for people (like me) who are decent, law abiding folks who have been taking methadone for chronic pain for years with good results. and then he downplayed the seriousness of withdrawals! but hey, he's a doctor, so what he said should go, right? right.
im in tuscaloosa, alabama, and i found out a couple of month ago that the illustrious sheriff here has done the same thing. no tobacco of any kind, and no "narcotic" type medicines of any kind. people who are dependent on methadone are administered one tablespoon (or was it teaspoon) of robitussin per day to "ease" their withdrawal symptoms. alabama and texas: two shining examples of a progressive society..

Chris said...

No where does it say she is an addict. Why do people automatically assume methadone means addict?? I am on methadone for chronic pain and my pain facility dropped me for no longer accepting my insurance with 80 others. 24 hours before my appointment they called to inform me of this. No doctor would help me, my pcp told me to go to the er, they treated me like an addict and told me there's nothing they can do. Im sitting in my pcp's office now waiting to see if he can help.....i run out tonight. Let me tell you how awful it is to be put into a category like this, when I work full time, make well into the six figures, and suffer from chronic nerve and back pain. Typical people categorizing others without knowing the story. Methadone HCL can be administered by any doctor.

Anonymous said...

You can die from methadone wthdrawal and it should be federal law that counties in every state detox a patient/inmate by 3 mg per week depending on amount.I'm a chronic pain patient with 6 herniated disc in my cervical spine and have been incarcerated from useing alcohol,herion or any other street drugs.The county should follow federal mandated laws for people in chronic pain or addiction recovery.Thats that period end of sentence.I would give my e-mail adress an phone number out,but it is hard for people that are not sick or in chronic pain to understand.I'm just a lay person,and really can't argue the sciene of pain treatment.however,it keeps the person from obtaining it from the street or robbing you or your home,and any prosecutor or judge would most likely agree with me.

Thank you ,Mason

Bulljacket said...

As a current methadone patient I can tell you that what happened to Amy and others like her that have died needlessly is horrible! Methadone withdrawal is the worst thing that has ever happened to me and I'm fortunate that I've only experienced it once after being arrested and locked up for four days! I've seen first hand how jailers and jail medical personnel treat people on methadone and it's not something that should ever happen! I don't know how many more people are going to have to die before the states get involved and make sure patients get the medicine instead of letting them die, but I hope no one else has to die before that happens! Unfortunately I'm afraid more will die before laws are passed to ensure this never happens again and that is so sad! To everyone talking about us patients and putting us down I'd suggest you walk one mile in our shoes and I guarantee you will look at us different! We are doctors, lawyers, police officers, teachers, truck drivers, managers, etc. etc. not just useless drug addicts!

Anonymous said...

When are the laws going to change? 75% of the people on methadone are dealing with chronic pain and mental health issues....Most times, they are people who've self medicated (since it's easier to get black market drugs than a controlled substance prescription) and are now labeled "addicts", and therefore, somehow less important or worthy of compassion.
I'm so encouraged to see that most of the comments here are intelligent, articulate arguments against our inhumane, assinine U.S. drug policies.
A signifigant number of the U.S. founding fathers were opiate addicts.
This stupidity has to end. It's no one's business what an adult puts in his/her own body (so long as it's not harming others).
The vast majority of people in prison today are there for non-violent drug "crimes".
Drug use is consistent in all income levels, but only the poor and middle class end up in prison.

Whitney Nuckolls said...

Youre right...er rooms only take patients in withdrawl back IMMEDIATLY if they r coming off alcohol or benzos..the only two drugs that cn kill u from withdrawl...if ths girl was on a daily PRESCRIBED medication of xanax, the jail should have been obligated to give her the xanax script...that is what killed her...if she was on xanax....it causes seizures and death from the withdrawl if u r taking a high enough dose....its stil on the jail for not taking death from BENZO withdrawl into account...prescribed or not....I am on methadone and have been thru the withdrawl...its the absolute worse and u WANT to die its so bad...but u wont.

Whitney Nuckolls said...

Youre right...er rooms only take patients in withdrawl back IMMEDIATLY if they r coming off alcohol or benzos..the only two drugs that cn kill u from withdrawl...if ths girl was on a daily PRESCRIBED medication of xanax, the jail should have been obligated to give her the xanax script...that is what killed her...if she was on xanax....it causes seizures and death from the withdrawl if u r taking a high enough dose....its stil on the jail for not taking death from BENZO withdrawl into account...prescribed or not....I am on methadone and have been thru the withdrawl...its the absolute worse and u WANT to die its so bad...but u wont.

Anonymous said...

This is simply inhumane. And the USA is supposed to be a ''civilised country?''. Why was this woman detained for so long anyway....for a mere traffic offence? unreal.

She would have been in insurmountable mental anguish, and physical pain. Methadone withdrawals are prolonged and severe..depending , of course on length of daily use and amount taken.
Even patients who have reduced to tiny doses suffer, but to withdraw ''cold turkey'' from a large does of methadone is going to be hideous. I have had a lot of experience with methadone, but until now, have not known of any deaths from withdrawal....maybe as I live in a ''civilised'' country, and prisons do allow methadone.It is tragic that Amy died from negligent care. May her soul be at peace.

tallymom said...

You are part of an ignorant majority.. I find your embarrassingly inept generalization about "most that YOU have encountered using methadone as a side dish' most shocking.
Find another profession sir. You are a danger to ALL that you "encounter".

Unknown said...

What is the G.P.A. of any county jail employed M.D? I suspect it is low enough to keep them out of Modern Main Stream Medicine ... Both of your arguments are myopic and actually Selfish. If you are not current on chronic pain treatment, you should not pretend that you are ... Chronic Pain Patient ;-(

Anonymous said...

This Prison Doc is full of cr##]. I cannot say this strongly enough. HE'S FULL OF cr##]. I was on Methadone for several years. And no I am not a Heroin addict. I have never shot up, snorted or dropped acid. I do, however have chronic pain.
I was dumped by my pain management provider and labeled a drug seeker even though I have severe spinal pain. I went through cold turkey withdrawals that can kill. For reasons still unclear to me I am still here. Without stroking, myocardial infarction and more than enough brain function to talk about it. Of course this PD is going to say it's all her fault. That's what they always do "Blame the patient" That's what was done to me. Oh, BTW Methadone withdrawals are not pleasant. It feels as though is shoveling pounds and pounds of crushed ice on you.
I hope that this woman's family really hammers this so called Doc in court. and I also hope that her family gets some REALLY Slick attorney who can clean this monster's clock.

Philly215 said...

I agree with you guys. I just got out of CFCF in Philadelphia, PA. They give methadone there if you are in a clinic for heroin or opiate withdrawal. I am prescribed 300mg. A day split in four doses thru the day from pain management, then take 30mg. Oxycodone tabs for breakthru pain. They would not give me anything. They said they don't give out that for pain, only for people who are at a clinic and were there before being locked up. I was transferred there from Bucks County prison, they give nothing either, not even methadone fir clinic patients. I was only down for 2 weeks. Inward horrible. And didn't seem lime it was even getting better. I think it was still getting worse. I feel so bad for my cellies, i was on that toilet more than ever been. If not shifting, then vomiting. Freezing, then hot, sweating, chills, crawling feeling on my skin, hard time breathing, rapid heartbeat, very high blood pressure. I was going thru it like never before. I thought oxycodone was hard coming off of. Methadone. Got it beat by a help of a lot. How long would have that have lasted? Well, I'm tired, have a good night, so glad that is over with and that I'm still alive.

faupauxs said...

Just wanted to give you a huge thumbs up Zenith!! I really hope more people will not have to die such horrible unnecessary deaths because of ignorance like that of Prison Doc here....and the jailers in this circumstance.